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General NPI Number Information
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NPI Number | 1881335321
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Entity Type | Organization
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Legal Business Name | CRYSTAL CARE AGENCY INC
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Dates
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Enumeration Date | 04/06/2022
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Last Update Date | 08/01/2022
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Provider Practice Location Address
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Address Line | 1629 K ST NW STE 300
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City | WASHINGTON
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State | DC
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Zip | 20006-1631
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Country | US
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Telephone | 202-203-9064
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Fax |
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Provider Business Mailing Address
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Address Line | 1629 K ST NW STE 300
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City | WASHINGTON
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State | DC
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Zip | 20006-1631
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Country | US
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Telephone | 202-203-9064
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF NURSING
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Name | FOLASADE MORADEYO
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Credential |
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Telephone | 202-203-9064
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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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 | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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License Number |
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License Number State |
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