Healthcare Provider Details

I. General information

NPI: 1811340821
Provider Name (Legal Business Name): CRYSTAL CLEAR SOLUTIONS L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2016
Last Update Date: 07/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E CENTER ST # 2999
MADISON SD
57042-2908
US

IV. Provider business mailing address

110 E CENTER ST # 2999
MADISON SD
57042-2908
US

V. Phone/Fax

Practice location:
  • Phone: 605-588-0141
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number251E00000X
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number253Z00000X
License Number StateSD

VIII. Authorized Official

Name: MS. CRYSTAL MEES
Title or Position: OWNER
Credential:
Phone: 605-588-0141