Provider Demographics
NPI:1376259762
Name:CAIN, CRYSTAL R
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:R
Last Name:CAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:881 NEW MILFORD RD
Mailing Address - Street 2:
Mailing Address - City:ATWATER
Mailing Address - State:OH
Mailing Address - Zip Code:44201-9205
Mailing Address - Country:US
Mailing Address - Phone:330-819-6630
Mailing Address - Fax:
Practice Address - Street 1:881 NEW MILFORD RD
Practice Address - Street 2:
Practice Address - City:ATWATER
Practice Address - State:OH
Practice Address - Zip Code:44201-9205
Practice Address - Country:US
Practice Address - Phone:330-819-6630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No347C00000XTransportation ServicesPrivate Vehicle