Organization
CRYSTAL CARE SUPPORT SERVICES, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SALLY KNUTSON RN, MA (ADMINISTRATOR)
(612) 861-4272
Entity
Organization
Contact information
Practice address
6461 LYNDALE AVE S, RICHFIELD, MN 55423-1405
(612) 861-4272
(612) 866-2290
Mailing address
6461 LYNDALE AVE S, RICHFIELD, MN 55423-1405
(612) 861-4272
(612) 866-2290
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
21157
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
21157
CLASS A LICENSE
MN
Enumeration date
06/08/2006
Last updated
08/22/2020
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