Provider Demographics
NPI:1821393257
Name:KRYSTAL HOME CARE AND STAFFING AGENCY LLC
Entity Type:Organization
Organization Name:KRYSTAL HOME CARE AND STAFFING AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALOYSIUS
Authorized Official - Middle Name:UZOMA
Authorized Official - Last Name:OKORO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-900-7699
Mailing Address - Street 1:3755 BENSON DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-7386
Mailing Address - Country:US
Mailing Address - Phone:919-900-7699
Mailing Address - Fax:919-900-7699
Practice Address - Street 1:3755 BENSON DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7386
Practice Address - Country:US
Practice Address - Phone:919-900-7699
Practice Address - Fax:919-900-7699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-15
Last Update Date:2011-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC4235251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health