Provider Demographics
NPI:1720774169
Name:MISS KRYSTAL CARES LLC
Entity Type:Organization
Organization Name:MISS KRYSTAL CARES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACTING MANAGER AGENT
Authorized Official - Prefix:
Authorized Official - First Name:KRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:HHA
Authorized Official - Phone:313-687-2479
Mailing Address - Street 1:18803 GARFIELD
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48240
Mailing Address - Country:US
Mailing Address - Phone:313-687-2479
Mailing Address - Fax:
Practice Address - Street 1:18803 GARFIELD
Practice Address - Street 2:
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48240
Practice Address - Country:US
Practice Address - Phone:313-687-2479
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-17
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health