Provider Demographics
NPI:1477031862
Name:CRYSTAL HEARTS HEALTHCARE SERVICES
Entity Type:Organization
Organization Name:CRYSTAL HEARTS HEALTHCARE SERVICES
Other - Org Name:CRYSTAL HEARTS HEALTHCARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAMARRALEE
Authorized Official - Middle Name:
Authorized Official - Last Name:CRANDALL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:951-445-0995
Mailing Address - Street 1:7080 ESTRELLA ST
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92880-3304
Mailing Address - Country:US
Mailing Address - Phone:951-407-3620
Mailing Address - Fax:
Practice Address - Street 1:7080 ESTRELLA ST
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92880-3304
Practice Address - Country:US
Practice Address - Phone:951-407-3620
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-30
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No291U00000XLaboratoriesClinical Medical Laboratory