MEDICARE: CRYSTAL HEALTH SERVICES

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	251E00000X	Home Health Agency
2	208100000X	Physical Medicine & Rehabilitation Physician

General Provider Information

NPI Number	:	1952024754
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRYSTAL HEALTH SERVICES

Provider Business Mailing Address
First Line	:	215 FAIRWOOD SPRINGS LN
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77406-3587
Country	:	US
Telephone Number	:	713-588-4881
Fax Number	:	281-206-4664

Provider Business Practice Location Address
First Line	:	2755 TEXAS PKWY STE 102
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77489-5114
Country	:	US
Telephone Number	:	713-588-4881
Fax Number	:	281-206-4664

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	KIKELOMO OLAWUNMI ADETOYINBO
Credential	:
Telephone Number	:	713-588-4881

Provider Enumeration Date	:	09/26/2022
Last Update Date	:	09/26/2022

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Directions to “CRYSTAL HEALTH SERVICES ” Practice Location

Language	Start Address	Practice Location

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