Provider Demographics
NPI:1346596871
Name:EMBASSY CRYSTAL CARE, LLC
Entity Type:Organization
Organization Name:EMBASSY CRYSTAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGAING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:B
Authorized Official - Last Name:HANDLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-439-7976
Mailing Address - Street 1:24579 BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:OAKWOOD VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44146-6338
Mailing Address - Country:US
Mailing Address - Phone:440-439-7976
Mailing Address - Fax:440-232-7113
Practice Address - Street 1:1251 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OH
Practice Address - Zip Code:44805-2810
Practice Address - Country:US
Practice Address - Phone:419-281-9595
Practice Address - Fax:419-282-9609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-02
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1268314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH366239Medicare Oscar/Certification