Healthcare Provider Details

I. General information

NPI: 1720774169
Provider Name (Legal Business Name): MISS KRYSTAL CARES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2023
Last Update Date: 01/17/2025
Certification Date: 01/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18803 GARFIELD
REDFORD MI
48240
US

IV. Provider business mailing address

18803 GARFIELD
REDFORD MI
48240
US

V. Phone/Fax

Practice location:
  • Phone: 313-687-2479
  • Fax:
Mailing address:
  • Phone: 313-687-2479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: KRYSTAL WILLIAMS
Title or Position: ACTING MANAGER AGENT
Credential: HHA
Phone: 313-687-2479