# CRYSTAL MEADOWS ESTATES, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1700128428
- **Authorized official:** JOHNATHAUN LEE (OWNER)
- **Authorized official phone:** (954) 479-9856

## Contact information

- **Practice address:** 4173 HEARTHSIDE DRIVE, 104, WILMINGTON, NC 28412-8335
- **Practice address phone:** (954) 479-9856
- **Mailing address:** 4173 HEARTHSIDE DRIVE, 104, WILMINGTON, NC 28412-8335
- **Mailing address phone:** (954) 479-9856

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 310500000X | Mental Illness Intermediate Care Facility | — | NULL | — |
| 311ZA0620X | Adult Care Home Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 03/20/2013
- **Last updated:** 03/20/2013