Healthcare Provider Details

I. General information

NPI: 1255448262
Provider Name (Legal Business Name): CRYSTAL SOCIAL SERVICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15819 SCHOOLCRAFT ST
DETROIT MI
48227-1749
US

IV. Provider business mailing address

15819 SCHOOLCRAFT ST
DETROIT MI
48227-1749
US

V. Phone/Fax

Practice location:
  • Phone: 313-493-4900
  • Fax: 313-493-4904
Mailing address:
  • Phone: 313-493-4900
  • Fax: 313-493-4904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT MCPHERSON
Title or Position: CEO
Credential:
Phone: 313-493-4900