MEDICARE: LILLIAN CRUMP

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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1811601487
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LILLIAN CRUMP

Provider Business Mailing Address
First Line	:	4072 PLATEAU ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43207-4650
Country	:	US
Telephone Number	:	614-625-4643
Fax Number	:

Provider Business Practice Location Address
First Line	:	4072 PLATEAU ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43207-4650
Country	:	US
Telephone Number	:	614-625-4643
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2023
Last Update Date	:	01/09/2023

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Directions to “ LILLIAN CRUMP ” Practice Location

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