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General NPI Number Information
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NPI Number | 1639383649
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Entity Type | Organization
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Legal Business Name | FIRST CRYSTALCARE, INC.
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Dates
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Enumeration Date | 05/09/2007
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Last Update Date | 10/04/2024
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Provider Practice Location Address
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Address Line | 1675 REPUBLIC PARKWAY, SUITE 200C 1675 REPUBLIC PARKWAY, SUITE 200C
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City | MESQUITE
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State | TX
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Zip | 75150-6902
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Country | US
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Telephone | 972-279-0682
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Fax | 972-279-0689
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Provider Business Mailing Address
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Address Line | 1675 REPUBLIC PARKWAY, SUITE 200C 1675 REPUBLIC PARKWAY, SUITE 200C
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City | MESQUITE
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State | TX
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Zip | 75150-6902
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Country | US
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Telephone | 972-279-0682
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Fax | 972-279-0689
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. KEYNA NKEMJIKA OMENUKOR
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Credential | APRN-CNP
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Telephone | 972-279-0682
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number |
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License Number State |
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Taxonomy #2
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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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