Healthcare Provider Details

I. General information

NPI: 1265340335
Provider Name (Legal Business Name): CRYSTAL HEALTH CARE SERVICES GROUP HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 GIBBSBORO RD
CLEMENTON NJ
08021-4134
US

IV. Provider business mailing address

245 GIBBSBORO RD
CLEMENTON NJ
08021-4134
US

V. Phone/Fax

Practice location:
  • Phone: 267-974-6150
  • Fax:
Mailing address:
  • Phone: 267-974-6150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: PASCAL IHEANYICHUKWU OSUJI
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 267-974-6150