Healthcare Provider Details

I. General information

NPI: 1336063726
Provider Name (Legal Business Name): CHRYSTAL I WILCHCOMBE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8535 BEECH DR APT E
STERLING HEIGHTS MI
48312-4728
US

IV. Provider business mailing address

7007 METROPOLITAN PKWY UNIT 861
STERLING HEIGHTS MI
48311-7140
US

V. Phone/Fax

Practice location:
  • Phone: 586-368-6648
  • Fax:
Mailing address:
  • Phone: 586-368-6648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: