Provider Demographics
NPI:1902329147
Name:CRYSTAL HOSPICE CARE LLC
Entity type:Organization
Organization Name:CRYSTAL HOSPICE CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:NOONAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-327-5590
Mailing Address - Street 1:801 E CAMPBELL RD STE 142
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-1856
Mailing Address - Country:US
Mailing Address - Phone:469-327-5590
Mailing Address - Fax:469-327-5557
Practice Address - Street 1:801 E CAMPBELL RD STE 142
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-1856
Practice Address - Country:US
Practice Address - Phone:469-327-5590
Practice Address - Fax:469-327-5557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-19
Last Update Date:2025-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001030974Medicaid