Organization
CRESCO CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANTON DEMENCHUK (EXECUTIVE DIRECTOR)
(646) 770-2691
Entity
Organization
Contact information
Practice address
9465 HOMEWOOD CIR, OOLTEWAH, TN 37363-5105
(423) 200-4422
Mailing address
PO BOX 1569, COLLEGEDALE, COLLEGEDALE, TN 37315-1569
(646) 770-2691
Taxonomy
Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
01/02/2013
Last updated
12/19/2013
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