Healthcare Provider Details

I. General information

NPI: 1508753427
Provider Name (Legal Business Name): CROWNED CRYSTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2622 LAVENDER LN
GLENN HEIGHTS TX
75154-2156
US

IV. Provider business mailing address

2622 LAVENDER LN
GLENN HEIGHTS TX
75154-2156
US

V. Phone/Fax

Practice location:
  • Phone: 225-678-8624
  • Fax:
Mailing address:
  • Phone: 214-601-8648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: CRYSTAL JUDSON STEWART
Title or Position: OWNER/CEO
Credential: RN, BSM, HHP
Phone: 214-601-8648