Provider Demographics
NPI:1114737137
Name:CRISSCARE SERVICES, LLC
Entity type:Organization
Organization Name:CRISSCARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KEONTE
Authorized Official - Middle Name:D
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:KEONTE D OWENS
Authorized Official - Phone:804-324-8259
Mailing Address - Street 1:805 LOUISIANA ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23231-1213
Mailing Address - Country:US
Mailing Address - Phone:804-324-8259
Mailing Address - Fax:
Practice Address - Street 1:805 LOUISIANA ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23231-1213
Practice Address - Country:US
Practice Address - Phone:804-324-8059
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-11
Last Update Date:2025-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities