Crystal Springs Home, Inc.

Primary specialty

In Home Supportive Care AgencyTaxonomy code 253Z00000X

Legal business name

CRYSTAL SPRINGS HOME, INC.

Practice address

799 Mount Etna Rd
Piketon, OH 45661-1101

Phone

(740) 493-2380

NPI assigned

Dec 27, 2020

Last updated

Dec 30, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Fredericka Wagner

Title

Executive Director

Phone

(740) 493-2380

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1609027200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1609286400000",
    "number": "1235726183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 845",
            "city": "PIKETON",
            "state": "OH",
            "postal_code": "456610845",
            "telephone_number": "740-493-2380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "799 MOUNT ETNA RD",
            "city": "PIKETON",
            "state": "OH",
            "postal_code": "456611101",
            "telephone_number": "740-493-2380"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRYSTAL SPRINGS HOME, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-27",
        "last_updated": "2020-12-30",
        "certification_date": "2020-12-30",
        "status": "A",
        "authorized_official_last_name": "WAGNER",
        "authorized_official_first_name": "FREDERICKA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "740-493-2380"
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chelsea K Conners, QMHS
• Cory Edward Cornett
• Wade Cottrell
• Anthony Wayne Cox
• Tiffany Irene Journey Crawford, MOT, OTR/L
• Luke William Culp
• Jordan Darlene Dailey, COTA/L
• Brandi Marie Dalton
• Gary Davis, CMS
• John Davis

• In Home Supportive Care Agency in Piketon, OH
• Providers in Piketon, OH by specialty
• In Home Supportive Care Agency in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2020; 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.