Crystal Fountain Home Services LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

CRYSTAL FOUNTAIN HOME SERVICES LLC

Practice address

1912 N State Road 53
Madison, FL 32340-3947

Phone

(850) 274-3131

NPI assigned

Aug 24, 2015

Last updated

Aug 24, 2015By 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

Mr. Albert Barfield

Title

MBR

Phone

(850) 661-2724

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1440374400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1440374400000",
    "number": "1689041865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1912 N STATE ROAD 53",
            "city": "MADISON",
            "state": "FL",
            "postal_code": "323403947",
            "telephone_number": "850-274-3131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1912 N STATE ROAD 53",
            "city": "MADISON",
            "state": "FL",
            "postal_code": "323403947",
            "telephone_number": "850-274-3131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRYSTAL FOUNTAIN HOME SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-24",
        "last_updated": "2015-08-24",
        "status": "A",
        "authorized_official_last_name": "BARFIELD",
        "authorized_official_first_name": "ALBERT",
        "authorized_official_title_or_position": "MBR",
        "authorized_official_telephone_number": "850-661-2724",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• CG Madison LLC (Madison Health and Rehabilitation Center)
• George Elton Cherry
• Thomas Wayne Conger, PHD
• County of Madison Office Clerk Board County Commissioners (Madison County Fire/Rescue)
• Katelynn Mae Croft
• Stacey Daniels
• Donna Davis
• Hope Davis
• Qarquasia Davis
• Tony Davis, R.N.

• Assisted Living Facility in Madison, FL
• Providers in Madison, FL by specialty
• Assisted Living Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2015; 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.