Organization
CRYSTALS PROMISE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CRYSTAL ANN ERNEST (DOO/OWNER)
(440) 415-2224
Entity
Organization
Contact information
Practice address
6250 N WATLING WAY, MADISON, OH 44057-1957
(440) 415-2224
Mailing address
6250 N WATLING WAY, MADISON, OH 44057-1957
(440) 415-2224
Taxonomy
Speciality
Code
Description
License number
State
174200000X
Meals Provider
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
251E00000X
Home Health Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
Other
Enumeration date
09/20/2023
Last updated
09/20/2023
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