Organization
KKJ ENTERPRISES, INC
Active
Other names
Crystal Care Center of Portsmouth
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CAROL SUE SAUER (ADMINISTRATOR)
(740) 354-6619
Entity
Organization
Contact information
Practice address
1319 SPRING STREET, PORTSMOUTH, OH 45662
(740) 354-6619
(740) 354-5710
Mailing address
PO BOX 439, 1319 SPRING STREET, PORTSMOUTH, OH 45662
(740) 354-6619
(740) 353-6770
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
OH
314000000X
Skilled Nursing Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0060574
—
OH
01
—
134209136
INSURANCE COMPANIES
OH
05
—
2335155
—
OH
Enumeration date
07/07/2005
Last updated
12/02/2013
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