Healthcare Provider Details

I. General information

NPI: 1346596871
Provider Name (Legal Business Name): EMBASSY CRYSTAL CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2012
Last Update Date: 08/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1251 E MAIN ST
ASHLAND OH
44805-2810
US

IV. Provider business mailing address

24579 BROADWAY AVE
OAKWOOD VILLAGE OH
44146-6338
US

V. Phone/Fax

Practice location:
  • Phone: 419-281-9595
  • Fax: 419-282-9609
Mailing address:
  • Phone: 440-439-7976
  • Fax: 440-232-7113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1268
License Number StateOH

VIII. Authorized Official

Name: AARON B HANDLER
Title or Position: MANAGAING MEMBER
Credential:
Phone: 440-439-7976