Crystal Care Home Health Services, Inc.

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

License

006494 Issued in TX

Legal business name

CRYSTAL CARE HOME HEALTH SERVICES, INC.

Doing business as

Crystal Care Home Health Services, Inc.

Practice address

1675 Republic Parkway
#200
Mesquite, TX 75150

Phone

(972) 203-2121

Fax

(972) 203-8384

NPI assigned

Aug 12, 2005

Organization subpart

No

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

Authorized official

Name

Keyna N Omenukor, RNNPI 1215307715

Title

Administrator

Phone

(972) 203-2121

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Crystal Care Home Health Services, Inc. Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Home health agency certification: CCN 459369

Legal name

CRYSTAL CARE HOME HEALTH SERVICES, INC.

Certification status

Active

Provider type (POS)

Home health agency

Participating since

Jul 22, 1997

Last certification

Aug 7, 2018

Ownership / control type

Proprietary

Organization structure

CorporationProprietary

Incorporated

Jan 23, 1997 in TX

Enrollment address

1675 Republic Parkway
Suite 200
Mesquite, TX 75150-6902

Listed as

Crystal Care Home Health Services IncCCN 459369

Overall star rating

1 of 5

Ownership

Proprietary

Certified

Jul 22, 1997

Medicare certification status

ActiveFrom the Provider of Services file

Services

Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

Locations

All disclosed owners & managing parties 1

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Keyna Omenukor

  • Psychiatric/Mental Health Nurse Practitioner
  • Mesquite, TX
  • NPI 1215307715

  5% Or Greater Direct Ownership Interest, Corporate Director, Corporate Officer, W-2 Managing Employee

  CMS ownership

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Keyna Omenukor

  • Psychiatric/Mental Health Nurse Practitioner
  • Mesquite, TX
  • NPI 1215307715
  NPD Authorized official

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

{
    "created_epoch": "1123804800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1383177600000",
    "number": "1598767162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1675 REPUBLIC PARKWAY",
            "address_2": "#200",
            "city": "MESQUITE",
            "state": "TX",
            "postal_code": "75150",
            "telephone_number": "972-203-2121",
            "fax_number": "972-203-8384"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1675 REPUBLIC PARKWAY",
            "address_2": "#200",
            "city": "MESQUITE",
            "state": "TX",
            "postal_code": "75150",
            "telephone_number": "972-203-2121",
            "fax_number": "972-203-8384"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRYSTAL CARE HOME HEALTH SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-12",
        "last_updated": "2013-10-31",
        "status": "A",
        "authorized_official_last_name": "OMENUKOR",
        "authorized_official_first_name": "KEYNA",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "972-203-2121",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "TX",
            "license": "006494",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000038800",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0008674000",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Crystal Care Home Health Services, Inc.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Credence Home and Community Services LLC
• Lana Gail Crenshaw, COTA
• Michelle Elizabeth Cribbin, DPT
• Crossroads Pharmacy
• Alicia Cruz, MS, LPC-A
• Culture Divine
• Cura Laboratory Services, LLC
• Jeremy James Curtis, D.M.D.
• Sandra Custodio, CCC-SLP
• CVS Home Health Agency Inc

• Home Health Agency in Mesquite, TX
• Providers in Mesquite, TX by specialty
• Home Health Agency in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• 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.