Provider Demographics
NPI:1780366203
Name:CRYSTAL CARE SERVICES LLC
Entity type:Organization
Organization Name:CRYSTAL CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MAMY
Authorized Official - Middle Name:GISELE
Authorized Official - Last Name:UWIMANA
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:682-521-4233
Mailing Address - Street 1:577 US ROUTE 1 UNIT B202
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-1312
Mailing Address - Country:US
Mailing Address - Phone:682-521-4233
Mailing Address - Fax:
Practice Address - Street 1:577 US ROUTE 1 UNIT B202
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-1312
Practice Address - Country:US
Practice Address - Phone:682-521-4233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities