Healthcare Provider Details

I. General information

NPI: 1043910763
Provider Name (Legal Business Name): CREST HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2023
Last Update Date: 03/09/2023
Certification Date: 03/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2210 BERKSHIRE RD
LANCASTER PA
17603-6104
US

IV. Provider business mailing address

2210 BERKSHIRE RD
LANCASTER PA
17603-6104
US

V. Phone/Fax

Practice location:
  • Phone: 717-330-7488
  • Fax:
Mailing address:
  • Phone: 717-330-7488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MRS. RADHIKA CHUWAN
Title or Position: MANAGING DIRECTOR
Credential:
Phone: 717-330-7488