Healthcare Provider Details

I. General information

NPI: 1841541372
Provider Name (Legal Business Name): CRYSTAL LYNN HOOVER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2012
Last Update Date: 09/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8621 SAINT PETERS CHURCH RD
LOUISVILLE OH
44641-9733
US

IV. Provider business mailing address

8621 SAINT PETERS CHURCH RD
LOUISVILLE OH
44641-9733
US

V. Phone/Fax

Practice location:
  • Phone: 330-935-2573
  • Fax:
Mailing address:
  • Phone: 330-935-2573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number400524680806
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: