Provider Demographics
NPI:1710769336
Name:KRYSTAL CLEAR LLC
Entity Type:Organization
Organization Name:KRYSTAL CLEAR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WALEED
Authorized Official - Middle Name:
Authorized Official - Last Name:OSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-896-2332
Mailing Address - Street 1:2649 VELOCITY RD
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-2579
Mailing Address - Country:US
Mailing Address - Phone:703-896-2332
Mailing Address - Fax:
Practice Address - Street 1:2649 VELOCITY RD
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20171-2579
Practice Address - Country:US
Practice Address - Phone:703-896-2332
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)