Provider Demographics
NPI:1023535929
Name:CRYSTAL REHAB & NURSING LLC
Entity type:Organization
Organization Name:CRYSTAL REHAB & NURSING LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMEBR
Authorized Official - Prefix:
Authorized Official - First Name:SHIMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEIBES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-588-8811
Mailing Address - Street 1:11 PONTIAC AVE
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01570-1629
Mailing Address - Country:US
Mailing Address - Phone:508-943-3889
Mailing Address - Fax:
Practice Address - Street 1:11 PONTIAC AVE
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:MA
Practice Address - Zip Code:01570-1629
Practice Address - Country:US
Practice Address - Phone:508-943-3889
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-23
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility