Provider Demographics
NPI:1053046342
Name:CRYSTAL LOGISTICS TRANSPORTATION AND HOME HEALTH CARE SERVICES,LLC
Entity Type:Organization
Organization Name:CRYSTAL LOGISTICS TRANSPORTATION AND HOME HEALTH CARE SERVICES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KIZZA
Authorized Official - Middle Name:E
Authorized Official - Last Name:KYEYUNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:774-251-7885
Mailing Address - Street 1:5 SUFFIELD ST APT 3
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01610-2358
Mailing Address - Country:US
Mailing Address - Phone:774-251-7885
Mailing Address - Fax:
Practice Address - Street 1:5 SUFFIELD ST APT 3
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01610-2358
Practice Address - Country:US
Practice Address - Phone:774-251-7885
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-20
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker