Healthcare Provider Details

I. General information

NPI: 1881898088
Provider Name (Legal Business Name): CRYSTAL SPRINGS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 NARROWS ROAD PO BOX 372
ASSONET MA
02702
US

IV. Provider business mailing address

38 NARROWS ROAD PO BOX 372
ASSONET MA
02702
US

V. Phone/Fax

Practice location:
  • Phone: 508-644-3101
  • Fax: 508-644-2008
Mailing address:
  • Phone: 508-644-3101
  • Fax: 508-644-2008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: KATHLEEN LOVENBURY
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 774-855-3176