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General NPI Number Information
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NPI Number | 1568743870
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Entity Type | Organization
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Legal Business Name | CRYSTAL'S SENIOR SERVICES LLC
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Dates
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Enumeration Date | 08/31/2011
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Last Update Date | 08/31/2011
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Provider Practice Location Address
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Address Line | 1945 PORTER ST
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City | SAN BERNARDINO
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State | CA
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Zip | 92407-6539
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Country | US
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Telephone | 909-887-1904
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Fax | 909-887-9734
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Provider Business Mailing Address
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Address Line | 1945 PORTER ST
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City | SAN BERNARDINO
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State | CA
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Zip | 92407-6539
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Country | US
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Telephone | 909-887-1904
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Fax | 909-887-9734
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Authorized Official
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Title or Position | FOUNDER / CEO
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Name | MS. CRYSTAL DOUGLAS
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Credential |
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Telephone | 909-887-1904
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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 |
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License Number State | CA
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