Crystal Edge 2 LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

CRYSTAL EDGE 2 LLC

Practice address

1979 Wilson Ave
Saint Paul, MN 55119-4046

Phone

(612) 459-2724

NPI assigned

Nov 27, 2024

Organization subpart

No

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

Authorized official

Name

Haja Uche, MANAGER

Title

Owner

Phone

(612) 459-2724

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

{
    "created_epoch": "1732665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732665600000",
    "number": "1841016458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10616 KYLE AVE N",
            "city": "BROOKLYN PARK",
            "state": "MN",
            "postal_code": "554431250",
            "telephone_number": "612-459-2724",
            "fax_number": "763-208-0912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1979 WILSON AVE",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551194046",
            "telephone_number": "612-459-2724"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRYSTAL EDGE 2 LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-11-27",
        "last_updated": "2024-11-27",
        "certification_date": "2024-11-27",
        "status": "A",
        "authorized_official_last_name": "UCHE",
        "authorized_official_first_name": "HAJA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "612-459-2724",
        "authorized_official_credential": "MANAGER"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Charles Edward Crutchfield, MD
• Chelsea Dennise Cruz, RN
• Selene Cruz
• Victoria Angela Cruz
• Sterline Cryer, MA, LISW
• Crystal Edge Mobility Services LLC
• Molly Cubinski
• Nicholas Allen Culp, PSYD
• Culture Home Healthcare Incorporated
• Jill Blair Culver, OTR/L, CLT

• Assisted Living Facility in Saint Paul, MN
• Providers in Saint Paul, MN by specialty
• Assisted Living Facility in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.