Provider Demographics
NPI:1538829411
Name:CRYSTAL LIFE TRANSITION SERVICES
Entity type:Organization
Organization Name:CRYSTAL LIFE TRANSITION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:GERTRUDE
Authorized Official - Middle Name:E
Authorized Official - Last Name:AFFUL-DANQUAH
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:267-312-1602
Mailing Address - Street 1:8859 ROOSEVELT BLVD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-1311
Mailing Address - Country:US
Mailing Address - Phone:267-312-1602
Mailing Address - Fax:
Practice Address - Street 1:8859 ROOSEVELT BLVD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-1311
Practice Address - Country:US
Practice Address - Phone:267-312-1602
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-20
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty