Provider Demographics
NPI:1699503169
Name:CRYSTAL RIVERS IN HOME CARE
Entity type:Organization
Organization Name:CRYSTAL RIVERS IN HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-512-7835
Mailing Address - Street 1:7072 BRYLINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32526-8410
Mailing Address - Country:US
Mailing Address - Phone:850-512-7835
Mailing Address - Fax:
Practice Address - Street 1:7072 BRYLINGTON BLVD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32526-8410
Practice Address - Country:US
Practice Address - Phone:850-512-7835
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care