Provider Demographics
NPI:1811182314
Name:CRYSTAL HOPE MEDICAL SERVICES, INC.
Entity type:Organization
Organization Name:CRYSTAL HOPE MEDICAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:ONYEAGORO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:310-529-3006
Mailing Address - Street 1:1300 W OLYMPIC BLVD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-3908
Mailing Address - Country:US
Mailing Address - Phone:310-529-3006
Mailing Address - Fax:
Practice Address - Street 1:1300 W OLYMPIC BLVD
Practice Address - Street 2:SUITE 320
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-3908
Practice Address - Country:US
Practice Address - Phone:310-529-3006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-08
Last Update Date:2007-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANOT YET251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health