Healthcare Provider Details

I. General information

NPI: 1134987464
Provider Name (Legal Business Name): CRYSTAL HEALTHCARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2024
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8585 COMMERCE PARK DR STE 580A
HOUSTON TX
77036-7427
US

IV. Provider business mailing address

8585 COMMERCE PARK DR STE 580A
HOUSTON TX
77036-7427
US

V. Phone/Fax

Practice location:
  • Phone: 832-891-9589
  • Fax:
Mailing address:
  • Phone: 832-891-9589
  • 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 Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL CHUKWUKA OBI
Title or Position: CEO
Credential:
Phone: 832-891-9589