Provider Demographics
NPI:1508581216
Name:CRISP HOME CARE, LLC
Entity Type:Organization
Organization Name:CRISP HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED SENIOR CARE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SAULE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHYNTEMIROVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-420-1324
Mailing Address - Street 1:26114 CROWN RANCH BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77316-1914
Mailing Address - Country:US
Mailing Address - Phone:936-283-4409
Mailing Address - Fax:
Practice Address - Street 1:525 WOODLAND SQUARE BLVD
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77384-2211
Practice Address - Country:US
Practice Address - Phone:936-283-4409
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite Care