Healthcare Provider Details

I. General information

NPI: 1508581216
Provider Name (Legal Business Name): CRISP HOME CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2022
Last Update Date: 10/05/2022
Certification Date: 10/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 WOODLAND SQUARE BLVD
CONROE TX
77384-2211
US

IV. Provider business mailing address

26114 CROWN RANCH BLVD
MONTGOMERY TX
77316-1914
US

V. Phone/Fax

Practice location:
  • Phone: 936-283-4409
  • Fax:
Mailing address:
  • Phone: 936-283-4409
  • 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: SAULE SHYNTEMIROVA
Title or Position: CERTIFIED SENIOR CARE MANAGER
Credential:
Phone: 832-420-1324