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General NPI Number Information
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NPI Number | 1174287916
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Entity Type | Organization
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Legal Business Name | CRYSTAL CARE NURSING AGENCY LLC
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Dates
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Enumeration Date | 10/27/2021
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Last Update Date | 01/26/2022
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Provider Practice Location Address
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Address Line | 11813 CHAREN LN
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City | POTOMAC
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State | MD
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Zip | 20854-3448
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Country | US
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Telephone | 240-898-7762
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Fax | 888-872-7931
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Provider Business Mailing Address
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Address Line | 11813 CHAREN LN
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City | POTOMAC
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State | MD
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Zip | 20854-3448
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Country | US
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Telephone | 240-898-7762
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Fax | 888-872-7931
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. OLUTUNJI OLUJIDE
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Credential | MD
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Telephone | 240-898-7762
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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