Provider Demographics
NPI:1609360544
Name:CRYSTAL HEALTH AND REHAB CENTER LLC
Entity Type:Organization
Organization Name:CRYSTAL HEALTH AND REHAB CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:EPHRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:LAHASKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-772-3668
Mailing Address - Street 1:99 W HAWTHORNE AVE STE L10
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-6126
Mailing Address - Country:US
Mailing Address - Phone:516-504-9797
Mailing Address - Fax:
Practice Address - Street 1:48 HIGH POINT RD
Practice Address - Street 2:
Practice Address - City:TAVERNIER
Practice Address - State:FL
Practice Address - Zip Code:33070-2006
Practice Address - Country:US
Practice Address - Phone:305-853-0799
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-14
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility