Provider Demographics
NPI:1225666217
Name:CRIMSON CORPORATIION
Entity Type:Organization
Organization Name:CRIMSON CORPORATIION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:J
Authorized Official - Last Name:WALLENTINE
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:208-350-7269
Mailing Address - Street 1:3023 E COPPER POINT DR STE 201
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-9290
Mailing Address - Country:US
Mailing Address - Phone:208-350-7269
Mailing Address - Fax:208-350-7271
Practice Address - Street 1:3023 E COPPER POINT DR STE 201
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-9290
Practice Address - Country:US
Practice Address - Phone:208-350-7269
Practice Address - Fax:208-350-7271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-27
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372600000XNursing Service Related ProvidersAdult CompanionGroup - Single Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty