Provider Demographics
NPI:1326476748
Name:CRYSTAL CARE & REHABILITATION CENTER, LLC
Entity Type:Organization
Organization Name:CRYSTAL CARE & REHABILITATION CENTER, LLC
Other - Org Name:CRYSTAL CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:STERN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-364-4009
Mailing Address - Street 1:1725 E 32ND ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-4441
Mailing Address - Country:US
Mailing Address - Phone:917-364-4009
Mailing Address - Fax:
Practice Address - Street 1:3245 VERA CRUZ AVE N
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55422-2708
Practice Address - Country:US
Practice Address - Phone:763-535-6260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-22
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility