Crystal Properties, Inc

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

770707 Issued in IA

Legal business name

CRYSTAL PROPERTIES, INC

Doing business as

Genesis Senior Living Center

Practice address

5608 SW 9TH St
Des Moines, IA 50315-5003

Phone

(515) 223-0758

Fax

(515) 223-9499

NPI assigned

Nov 9, 2006

Last updated

Aug 22, 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

Randy Lange

Title

Owner

Phone

(515) 223-0758

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Genesis Senior Living Center Doing business as

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

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1952471401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5608 SW 9TH ST",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503155003",
            "telephone_number": "515-223-0758",
            "fax_number": "515-223-9499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5608 SW 9TH ST",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503155003",
            "telephone_number": "515-223-0758",
            "fax_number": "515-223-9499"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRYSTAL PROPERTIES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-09",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LANGE",
        "authorized_official_first_name": "RANDY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "515-223-0758"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IA",
            "license": "770707",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0807354",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER #",
            "identifier": "65175",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Genesis Senior Living Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Amanda Hope Croxton, D.O.
• David Alan Croy, 251E0000OX
• Sarah Crumly
• Cassandra Marie Cruz, LMSW
• Sierra Cruz, LMSW
• Carley Cueva, DO
• Terence J Cullen Jr., DO
• Gabriel A Cullom
• James Cummings, MD
• Anne Cundiff

• Skilled Nursing Facility in Des Moines, IA
• Providers in Des Moines, IA by specialty
• Skilled Nursing Facility in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.