Organization
CRYSTAL PROPERTIES, INC
Active
Other names
Genesis Senior Living Center
Organization subpart
No
Provider details
NPI number
Authorized official
RANDY LANGE (OWNER)
(515) 223-0758
Entity
Organization
Contact information
Practice address
5608 SW 9TH ST, DES MOINES, IA 50315-5003
(515) 223-0758
(515) 223-9499
Mailing address
5608 SW 9TH ST, DES MOINES, IA 50315-5003
(515) 223-0758
(515) 223-9499
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
770707
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0807354
—
IA
01
—
65175
BCBS PROVIDER #
IA
Enumeration date
11/09/2006
Last updated
08/22/2020
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