Provider Demographics
NPI:1598912917
Name:CRYSTAL SEASONS LIVING COMMUNITY
Entity Type:Organization
Organization Name:CRYSTAL SEASONS LIVING COMMUNITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:THRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-625-8741
Mailing Address - Street 1:PO BOX 1236
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56002-1236
Mailing Address - Country:US
Mailing Address - Phone:507-625-8741
Mailing Address - Fax:507-387-4838
Practice Address - Street 1:222 S MURPHY ST
Practice Address - Street 2:
Practice Address - City:LAKE CRYSTAL
Practice Address - State:MN
Practice Address - Zip Code:56055-2128
Practice Address - Country:US
Practice Address - Phone:507-726-2266
Practice Address - Fax:507-726-2276
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE THRO COMPANY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-08-27
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility