Provider Demographics
NPI:1639383649
Name:FIRST CRYSTALCARE, INC.
Entity Type:Organization
Organization Name:FIRST CRYSTALCARE, INC.
Other - Org Name:CRYSTALCARE HEALTH SYSTEM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:AGU
Authorized Official - Last Name:OMENUKOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-203-2121
Mailing Address - Street 1:1675 REPUBLIC PARKWAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-6902
Mailing Address - Country:US
Mailing Address - Phone:972-203-2121
Mailing Address - Fax:972-279-6648
Practice Address - Street 1:1675 REPUBLIC PARKWAY
Practice Address - Street 2:SUITE 200
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-6902
Practice Address - Country:US
Practice Address - Phone:972-203-2121
Practice Address - Fax:972-279-6648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health