Crystal Lake Memory Care, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

5102865 Issued in IL

Legal business name

CRYSTAL LAKE MEMORY CARE, LLC

Practice address

495 Alexandra Blvd
Crystal Lake, IL 60014-8908

Phone

(815) 459-7800

Fax

(815) 356-3066

NPI assigned

Feb 20, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Chad Anderson

Title

President

Phone

(214) 845-4500

Specialties & licenses 1

Addresses

Other names 1

• Autumn Leaves of Crystal Lake Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Autumn Leaves of Clear Lake2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Clear Lake Memory Care, LLC

  • Assisted Living Facility
  • Irving, TX
  • NPI 1881954592
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1329696000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1329696000000",
    "number": "1164795308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "545 E JOHN CARPENTER FWY",
            "address_2": "SUITE 500",
            "city": "IRVING",
            "state": "TX",
            "postal_code": "750623931",
            "telephone_number": "214-845-4500",
            "fax_number": "214-845-4501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "495 ALEXANDRA BLVD",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600148908",
            "telephone_number": "815-459-7800",
            "fax_number": "815-356-3066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRYSTAL LAKE MEMORY CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-20",
        "last_updated": "2012-02-20",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "CHAD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "214-845-4500",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "IL",
            "license": "5102865",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Autumn Leaves of Crystal Lake",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Crystal Lake Family Treatment Center LTD
• Crystal Lake Family Wellness
• Crystal Lake Foot & Ankle Center LLC
• Crystal Lake Immediate Care Physicians LTD.
• Crystal Lake Medical and Sports Rehab SC
• Crystal Lake Natural Health Care
• Crystal Lake Ophthalmology Associates PC
• Crystal Lake Optical Inc.
• Crystal Lake Oral Maxillofacial Surgery LTD
• Crystal Lake Pediatric Dental LTD.

• Assisted Living Facility in Crystal Lake, IL
• Providers in Crystal Lake, IL by specialty
• Assisted Living Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.