Crystal Gem Manor

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

AL10687 Issued in FL

Legal business name

CRYSTAL GEM MANOR

Practice address

10845 W Gem St
Crystal River, FL 34428-6682

Phone

(352) 794-7601

NPI assigned

May 30, 2013

Organization subpart

No

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

Authorized official

Name

Jorge A Hernando

Title

Owner

Phone

(305) 868-1830

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Crystal Gem Manor2 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.

• Crystal Gem Manor

  • Assisted Living Facility
  • Crystal River, FL
  • NPI 1386094837
  NPD tax ID

Locations

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

{
    "created_epoch": "1369872000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1369872000000",
    "number": "1750728812",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 71ST ST STE 410",
            "city": "MIAMI BEACH",
            "state": "FL",
            "postal_code": "331413092",
            "telephone_number": "305-868-1830"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10845 W GEM ST",
            "city": "CRYSTAL RIVER",
            "state": "FL",
            "postal_code": "344286682",
            "telephone_number": "352-794-7601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRYSTAL GEM MANOR",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-30",
        "last_updated": "2013-05-30",
        "status": "A",
        "authorized_official_last_name": "HERNANDO",
        "authorized_official_first_name": "JORGE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "305-868-1830"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "AL10687",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0003517200",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rebecca Cretty
• Carrie Crochetiere
• Gerilyn E. Cross, M.D.
• Crystal Community E N T
• Crystal Gem Manor
• Crystal Home Medical Equipment Inc
• Crystal Palace Senior Living LLC
• Crystal River Anesthesia Associates, LLC
• Crystal River Behavioral Health LLC
• Crystal River Endoscopy ASC LP

• Assisted Living Facility in Crystal River, FL
• Providers in Crystal River, 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 May 30, 2013; 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.