Provider Demographics
NPI:1720459688
Name:CHRISTAL CARE SERVICES
Entity type:Organization
Organization Name:CHRISTAL CARE SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OBASI
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUKWUNENYE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-280-3991
Mailing Address - Street 1:4240 OLD YORK RD
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19140-2050
Mailing Address - Country:US
Mailing Address - Phone:215-456-9007
Mailing Address - Fax:
Practice Address - Street 1:4240 OLD YORK RD
Practice Address - Street 2:SUITE 1A
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-2050
Practice Address - Country:US
Practice Address - Phone:215-456-9007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-16
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health