Provider Demographics
NPI:1952024754
Name:CRYSTAL HEALTH SERVICES
Entity Type:Organization
Organization Name:CRYSTAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KIKELOMO
Authorized Official - Middle Name:OLAWUNMI
Authorized Official - Last Name:ADETOYINBO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-588-4881
Mailing Address - Street 1:215 FAIRWOOD SPRINGS LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-3587
Mailing Address - Country:US
Mailing Address - Phone:713-588-4881
Mailing Address - Fax:281-206-4664
Practice Address - Street 1:2755 TEXAS PKWY STE 102
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77489-5114
Practice Address - Country:US
Practice Address - Phone:713-588-4881
Practice Address - Fax:281-206-4664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No251E00000XAgenciesHome HealthGroup - Multi-Specialty