Provider Demographics
NPI:1336230929
Name:CRYSTAL HOME HEALTHCARE
Entity Type:Organization
Organization Name:CRYSTAL HOME HEALTHCARE
Other - Org Name:N/A
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RN, ADM/DON
Authorized Official - Prefix:MRS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:NNEKA
Authorized Official - Last Name:EZEUDE
Authorized Official - Suffix:
Authorized Official - Credentials:BSN
Authorized Official - Phone:281-384-5366
Mailing Address - Street 1:2012 WILDWOOD RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77489-3066
Mailing Address - Country:US
Mailing Address - Phone:281-384-5366
Mailing Address - Fax:281-403-2806
Practice Address - Street 1:2012 WILDWOOD RIDGE DR
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77489-3066
Practice Address - Country:US
Practice Address - Phone:281-384-5366
Practice Address - Fax:281-403-2806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009963251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health