Provider Demographics
NPI:1093593006
Name:CRYSTALS PROMISE LLC
Entity Type:Organization
Organization Name:CRYSTALS PROMISE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOO/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ERNEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-415-2224
Mailing Address - Street 1:6250 N WATLING WAY
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:OH
Mailing Address - Zip Code:44057-1957
Mailing Address - Country:US
Mailing Address - Phone:440-415-2224
Mailing Address - Fax:
Practice Address - Street 1:6250 N WATLING WAY
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:OH
Practice Address - Zip Code:44057-1957
Practice Address - Country:US
Practice Address - Phone:440-415-2224
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-20
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No174200000XOther Service ProvidersMeals
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251E00000XAgenciesHome Health
No251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child