Provider Demographics
NPI:1477798932
Name:CRYSTAL BLUE SAPPHIRE HCS LLC
Entity Type:Organization
Organization Name:CRYSTAL BLUE SAPPHIRE HCS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DANYELL
Authorized Official - Middle Name:GRACE
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-335-4346
Mailing Address - Street 1:14107 BRAYFORD PLACE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77014-2063
Mailing Address - Country:US
Mailing Address - Phone:832-335-4346
Mailing Address - Fax:
Practice Address - Street 1:14107 BRAYFORD PLACE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77014-2063
Practice Address - Country:US
Practice Address - Phone:832-335-4346
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-11
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251C00000X251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health