Provider Demographics
NPI:1437760501
Name:CRYSTAL HOME CARE SERVICES LLC
Entity Type:Organization
Organization Name:CRYSTAL HOME CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:THUHIEN
Authorized Official - Middle Name:THI
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-592-9129
Mailing Address - Street 1:1065 MARIE ST
Mailing Address - Street 2:
Mailing Address - City:FOREST PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30297-3851
Mailing Address - Country:US
Mailing Address - Phone:714-592-9129
Mailing Address - Fax:678-974-8980
Practice Address - Street 1:1065 MARIE ST
Practice Address - Street 2:
Practice Address - City:FOREST PARK
Practice Address - State:GA
Practice Address - Zip Code:30297-3851
Practice Address - Country:US
Practice Address - Phone:714-592-9129
Practice Address - Fax:678-974-8980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health