Provider Demographics
NPI:1881898088
Name:CRYSTAL SPRINGS, INC.
Entity type:Organization
Organization Name:CRYSTAL SPRINGS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LOVENBURY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:774-855-3176
Mailing Address - Street 1:38 NARROWS ROAD
Mailing Address - Street 2:PO BOX 372
Mailing Address - City:ASSONET
Mailing Address - State:MA
Mailing Address - Zip Code:02702
Mailing Address - Country:US
Mailing Address - Phone:508-644-3101
Mailing Address - Fax:508-644-2008
Practice Address - Street 1:38 NARROWS ROAD
Practice Address - Street 2:PO BOX 372
Practice Address - City:ASSONET
Practice Address - State:MA
Practice Address - Zip Code:02702
Practice Address - Country:US
Practice Address - Phone:508-644-3101
Practice Address - Fax:508-644-2008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1318071Medicaid