Crystal Care Nursing Agency LLC

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

CRYSTAL CARE NURSING AGENCY LLC

Practice address

11813 Charen LN
Potomac, MD 20854-3448

Phone

(240) 898-7762

Fax

(888) 872-7931

NPI assigned

Oct 27, 2021

Organization subpart

No

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

Authorized official

Name

Mr. Olutunji Olujide, MD

Title

Administrator

Phone

(240) 898-7762

Specialties & licenses 1

Addresses

Other names 1

• CYSTAL CARE NURSING AGENCY Doing business as

Electronic endpoints 2

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

{
    "created_epoch": "1635292800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643155200000",
    "number": "1174287916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11813 CHAREN LN",
            "city": "POTOMAC",
            "state": "MD",
            "postal_code": "208543448",
            "telephone_number": "240-898-7762",
            "fax_number": "888-872-7931"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11813 CHAREN LN",
            "city": "POTOMAC",
            "state": "MD",
            "postal_code": "208543448",
            "telephone_number": "240-898-7762",
            "fax_number": "888-872-7931"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRYSTAL CARE NURSING AGENCY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-27",
        "last_updated": "2022-01-26",
        "certification_date": "2022-01-26",
        "status": "A",
        "authorized_official_last_name": "OLUJIDE",
        "authorized_official_first_name": "OLUTUNJI",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "240-898-7762",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "hakglobal@gmail.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "11813 Charen Ln",
            "city": "Potomac",
            "state": "MD",
            "country_code": "US",
            "postal_code": "208543448",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "hakglobal@gmail.com",
            "affiliation": "N",
            "endpointDescription": "hakglobal@gmail.com",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "11813 Charen Ln",
            "city": "Potomac",
            "state": "MD",
            "country_code": "US",
            "postal_code": "208543448",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "CYSTAL CARE NURSING AGENCY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CYSTAL CARE NURSING AGENCY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.