Provider Demographics
NPI:1720360316
Name:A CRYSTAL HOME HEALTH
Entity Type:Organization
Organization Name:A CRYSTAL HOME HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAGOBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:CORREA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-279-8071
Mailing Address - Street 1:69 MARIA ST
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78829-0473
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:69 MARIA ST
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:TX
Practice Address - Zip Code:78829-0473
Practice Address - Country:US
Practice Address - Phone:830-279-8071
Practice Address - Fax:830-279-8071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-09
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health