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Organization
CRYSTAL MEADOWS ESTATES, LLC
Active
Organization
CRYSTAL MEADOWS ESTATES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHNATHAUN LEE (OWNER)
(954) 479-9856
Entity
Organization
Contact information
Practice address
4173 HEARTHSIDE DRIVE, 104, WILMINGTON, NC 28412-8335
(954) 479-9856
Mailing address
4173 HEARTHSIDE DRIVE, 104, WILMINGTON, NC 28412-8335
(954) 479-9856
Taxonomy
Speciality
Code
Description
License number
State
310500000X
Mental Illness Intermediate Care Facility
—
NULL
311ZA0620X
Adult Care Home Facility
Primary
—
NULL
Other
Enumeration date
03/20/2013
Last updated
03/20/2013
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