Provider Demographics
NPI:1477370468
Name:CRYSTAL ROYAL CARE
Entity type:Organization
Organization Name:CRYSTAL ROYAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LUSTY
Authorized Official - Middle Name:
Authorized Official - Last Name:BINEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-813-7999
Mailing Address - Street 1:128 NORTH DR
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-5108
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:128 NORTH DR
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-5108
Practice Address - Country:US
Practice Address - Phone:717-813-7999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities