Individual
CRYSTAL HALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1241 N 58TH ST, PHILADELPHIA, PA 19131-4108
(267) 680-5974
Mailing address
1241 N 58TH ST, PHILADELPHIA, PA 19131-4108
(267) 680-5974
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
61493601
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103981425-0001
—
PA
Enumeration date
09/30/2024
Last updated
10/14/2024
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