=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265340335
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CRYSTAL HEALTH CARE SERVICES GROUP HOME
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2026
-----------------------------------------------------
Last Update Date | 08/31/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 245 GIBBSBORO RD
-----------------------------------------------------
City | CLEMENTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08021-4134
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 267-974-6150
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 245 GIBBSBORO RD
-----------------------------------------------------
City | CLEMENTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08021-4134
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 267-974-6150
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | PASCAL IHEANYICHUKWU OSUJI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 267-974-6150
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------