Healthcare Provider Details

I. General information

NPI: 1942473210
Provider Name (Legal Business Name): CRYSTAL HOME HEALTH AGENCY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2008
Last Update Date: 04/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1416 HICKORY CREEK LN
ROCKWALL TX
75032-7334
US

IV. Provider business mailing address

1416 HICKORY CREEK LN
ROCKWALL TX
75032-7334
US

V. Phone/Fax

Practice location:
  • Phone: 713-459-5983
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. BERNADETTE IGUH
Title or Position: ADMINISTRATOR/DIRECTOR
Credential:
Phone: 713-459-5983