MEDICARE: CRYSTALWOOD, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	311500000X	Alzheimer Center (Dementia Center)	5072	OH
2	311500000X	Alzheimer Center (Dementia Center)	5066	OH
3	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1538207444
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRYSTALWOOD, INC.

Provider Business Mailing Address
First Line	:	70 DAMON RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45218-1041
Country	:	US
Telephone Number	:	513-605-1000
Fax Number	:	513-825-2998

Provider Business Practice Location Address
First Line	:	70 DAMON RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45218-1041
Country	:	US
Telephone Number	:	513-605-1000
Fax Number	:	513-825-2998

Authorized Official
Title or Position	:	EXECUTIVE VICE PRESIDENT
Name	:	MR. GREGORY S MILLER
Credential	:
Telephone Number	:	513-605-1000

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	04/26/2023

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Directions to “CRYSTALWOOD, INC. ” Practice Location

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