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General NPI Number Information
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NPI Number | 1679367510
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Entity Type | Organization
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Legal Business Name | CRYSTAL HOME CARE AZ LLC
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Dates
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Enumeration Date | 04/07/2025
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Last Update Date | 04/24/2025
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Provider Practice Location Address
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Address Line | 2025 N 3RD ST STE B300
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City | PHOENIX
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State | AZ
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Zip | 85004-1471
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Country | US
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Telephone | 602-345-9299
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Fax |
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Provider Business Mailing Address
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Address Line | 1382 LANES MILL RD STE 104
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City | LAKEWOOD
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State | NJ
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Zip | 08701-3893
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MENACHEM SHMUELI
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Credential |
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Telephone | 917-753-9089
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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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