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General NPI Number Information
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NPI Number | 1083579833
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Entity Type | Organization
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Legal Business Name | CRYSTAL ETHAN SUPPORT CARE LLC
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Dates
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Enumeration Date | 12/23/2025
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Last Update Date | 12/23/2025
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Provider Practice Location Address
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Address Line | 7517 PROVIDENCE WOODS CT
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City | WEST CHESTER
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State | OH
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Zip | 45069-1172
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Country | US
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Telephone | 513-371-0956
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Fax |
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Provider Business Mailing Address
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Address Line | 7517 PROVIDENCE WOODS CT
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City | WEST CHESTER
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State | OH
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Zip | 45069-1172
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Country | US
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Telephone | 513-371-0956
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | OLUFEMI EMMANUEL BEWAJI
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Credential |
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Telephone | 513-371-0956
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 376J00000X
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Taxonomy Name | Homemaker
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License Number |
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License Number State |
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