MEDICARE: CRYSTAL MINDS HELP L.L.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1437757416
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRYSTAL MINDS HELP L.L.C.

Provider Business Mailing Address
First Line	:	1365 NW 127TH ST
Second Line	:
City	:	NORTH MIAMI
State	:	FL
Zip	:	33167-2205
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1365 NW 127TH ST
Second Line	:
City	:	NORTH MIAMI
State	:	FL
Zip	:	33167-2205
Country	:	US
Telephone Number	:	786-209-8996
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	YAIMARELYS GRANDALES
Credential	:
Telephone Number	:	786-209-8996

Provider Enumeration Date	:	10/13/2020
Last Update Date	:	10/13/2020

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