Provider Demographics
NPI:1174287916
Name:CRYSTAL CARE NURSING AGENCY LLC
Entity type:Organization
Organization Name:CRYSTAL CARE NURSING AGENCY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:OLUTUNJI
Authorized Official - Middle Name:
Authorized Official - Last Name:OLUJIDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-898-7762
Mailing Address - Street 1:11813 CHAREN LN
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-3448
Mailing Address - Country:US
Mailing Address - Phone:240-898-7762
Mailing Address - Fax:888-872-7931
Practice Address - Street 1:11813 CHAREN LN
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-3448
Practice Address - Country:US
Practice Address - Phone:240-898-7762
Practice Address - Fax:888-872-7931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-27
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health