Provider Demographics
NPI:1164922613
Name:CRYSTAL NURSING SERVICE
Entity Type:Organization
Organization Name:CRYSTAL NURSING SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP / ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:KIRK
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-409-8260
Mailing Address - Street 1:980 N FEDERAL HWY
Mailing Address - Street 2:110
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-2708
Mailing Address - Country:US
Mailing Address - Phone:561-409-8260
Mailing Address - Fax:561-409-8250
Practice Address - Street 1:980 N FEDERAL HWY
Practice Address - Street 2:110
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-2708
Practice Address - Country:US
Practice Address - Phone:561-409-8260
Practice Address - Fax:561-409-8250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-20
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL30211911253Z00000X, 374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty