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General NPI Number Information
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NPI Number | 1164922613
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Entity Type | Organization
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Legal Business Name | CRYSTAL NURSING SERVICE
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Dates
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Enumeration Date | 02/20/2018
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Last Update Date | 02/20/2018
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Provider Practice Location Address
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Address Line | 980 N FEDERAL HWY 110
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City | BOCA RATON
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State | FL
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Zip | 33432-2708
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Country | US
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Telephone | 561-409-8260
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Fax | 561-409-8250
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Provider Business Mailing Address
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Address Line | 980 N FEDERAL HWY 110
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City | BOCA RATON
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State | FL
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Zip | 33432-2708
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Country | US
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Telephone | 561-409-8260
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Fax | 561-409-8250
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Authorized Official
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Title or Position | VP / ADMINISTRATOR
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Name | MR. PATRICK KIRK THOMPSON
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Credential |
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Telephone | 561-409-8260
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 30211911
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number | 30211911
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License Number State | FL
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