Provider Demographics
NPI:1922741172
Name:KRYSTAL HOME SERVICES LLC
Entity Type:Organization
Organization Name:KRYSTAL HOME SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KRYSTAL
Authorized Official - Middle Name:B
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:754-367-9068
Mailing Address - Street 1:5649 SW 27TH ST APT 2
Mailing Address - Street 2:
Mailing Address - City:WEST PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33023-4119
Mailing Address - Country:US
Mailing Address - Phone:754-367-9068
Mailing Address - Fax:
Practice Address - Street 1:5649 SW 27TH ST APT 2
Practice Address - Street 2:
Practice Address - City:WEST PARK
Practice Address - State:FL
Practice Address - Zip Code:33023-4119
Practice Address - Country:US
Practice Address - Phone:754-367-9068
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-15
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty