Provider Demographics
NPI:1821043332
Name:CRYSTAL HOME HEALTH CARE SERVICES,INC.
Entity Type:Organization
Organization Name:CRYSTAL HOME HEALTH CARE SERVICES,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLADYS
Authorized Official - Middle Name:A
Authorized Official - Last Name:MAGSINO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:562-427-3690
Mailing Address - Street 1:3939 ATLANTIC AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-3536
Mailing Address - Country:US
Mailing Address - Phone:562-427-3690
Mailing Address - Fax:562-427-3847
Practice Address - Street 1:3939 ATLANTIC AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-3536
Practice Address - Country:US
Practice Address - Phone:562-427-3690
Practice Address - Fax:562-427-3847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA980001450251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA08210FMedicaid
CAHHA08210FMedicaid