Healthcare Provider Details

I. General information

NPI: 1255346870
Provider Name (Legal Business Name): CRYSTAL HOME HEALTHCARE PHCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 09/11/2025
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:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number5301008320
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN ADAMS
Title or Position: PHCY MGR
Credential: RPH
Phone: 313-493-4900