Organization
CRYSTAL DIETARY SERVICE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT MCPHERSON (CEO)
(313) 493-4900
Entity
Organization
Contact information
Practice address
15819 SCHOOLCRAFT ST, DETROIT, MI 48227-1749
(313) 493-4900
(313) 493-4904
Mailing address
15819 SCHOOLCRAFT ST, DETROIT, MI 48227-1749
(313) 493-4900
(313) 493-4904
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4377557
—
MI
Enumeration date
08/24/2006
Last updated
08/22/2020
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