| Cresco Care Llc | |
|
9465 Homewood Cir Ooltewah TN 37363-5105 | |
| (423) 200-4422 | |
| Not Available |
| Full Name | Cresco Care Llc |
|---|---|
| Speciality | Clinic/center - Adolescent And Children Mental Health |
| Location | 9465 Homewood Cir, Ooltewah, Tennessee |
| Authorized Official Name and Position | Anton Demenchuk (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 6467702691 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Cresco Care Llc Po Box 1569 Collegedale Collegedale TN 37315-1569 Ph: (646) 770-2691 | Cresco Care Llc 9465 Homewood Cir Ooltewah TN 37363-5105 Ph: (423) 200-4422 |
| NPI Number | 1730425240 |
|---|---|
| Provider Enumeration Date | 01/02/2013 |
| Last Update Date | 12/19/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730425240 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Primary |
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