Provider Demographics
NPI:1790960532
Name:KRYSTAL HOME HEALTH SERVICES
Entity Type:Organization
Organization Name:KRYSTAL HOME HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:FLORI
Authorized Official - Middle Name:YEVETT
Authorized Official - Last Name:ONWUMERE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:281-499-9808
Mailing Address - Street 1:12619 GROVE PARK DR
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77489-3923
Mailing Address - Country:US
Mailing Address - Phone:281-499-9808
Mailing Address - Fax:281-499-8496
Practice Address - Street 1:12619 GROVE PARK DR
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77489-3923
Practice Address - Country:US
Practice Address - Phone:281-499-9808
Practice Address - Fax:281-499-8496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-28
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX010901251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health