Provider Demographics
NPI:1902329147
Name:CRYSTAL HOSPICE CARE LLC
Entity Type:Organization
Organization Name:CRYSTAL HOSPICE CARE LLC
Other - Org Name:QUANTUM HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BETSON
Authorized Official - Middle Name:
Authorized Official - Last Name:ZACHARIAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-941-9522
Mailing Address - Street 1:14140 MIDWAY RD STE 104
Mailing Address - Street 2:
Mailing Address - City:FARMERS BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:75244-3707
Mailing Address - Country:US
Mailing Address - Phone:214-930-2386
Mailing Address - Fax:469-722-3622
Practice Address - Street 1:14110 DALLAS PKWY STE 170
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75254-1367
Practice Address - Country:US
Practice Address - Phone:214-941-9522
Practice Address - Fax:972-546-4792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-19
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001030974Medicaid