CRYSTAL SERENITY HOUSE (NPI# 1376080614) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1376080614 |
| Entity Type | Organization |
| Organization Name | CRYSTAL SERENITY HOUSE |
| Practice Address |
14241 Faust Ave Ste 200-b Detroit MI 48223-3574 |
| Practice Telephone | 8886096012 |
| Practice Fax Number | 3137363471 |
| Mailing Telephone | 8886096012 |
| Mailing Fax Number | 3137363471 |
| Enumeration Date | 2017-01-25 |
| Last Update Date | 2017-01-25 |
| Authorized Official Name | CRYSTAL NUNNERY (MANAGER) |
| Authorized Official Telephone | 7347098296 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 311ZA0620X |
Custodial Care Facility Specialization: Adult Care Home |
Nursing & Custodial Care Facilities |
| Street Address |
14241 FAUST AVE STE 200-B |
| City | DETROIT |
| State | MI |
| Zip Code | 48223-3574 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366946659 | From Heavens Joy Assisted Care Support Services LLC | Social Worker | 14179 Evergreen Rd, Detroit, MI 48223 | 2018-03-21 |
| 1164921144 | Kyara Mccraney | Licensed Practical Nurse | 12725 Riverview St, Detroit, MI 48223 | 2018-02-06 |
| 1922516384 | Cynthia Clair Reese | Nursing Home Administrator | 22625 Glendale, Det, MI 48223 | 2018-01-18 |
| 1629590609 | Marie Davis | Nursing Care | 14049 Minock St, Detroit, MI 48223 | 2017-07-12 |
| 1740726488 | Tanisha Smith | Behavior Technician | 14620 Faust Ave, Detroit, MI 48223 | 2017-01-18 |
| 1518418730 | Tamica K Boyd | Emergency Medical Technician, Basic | 15890 Lamphere, Detroit, MI 48223 | 2016-10-24 |
| 1831596832 | Walter Ector | Counselor | 14243 Minock, Detroit, MI 48223 | 2014-11-20 |
| 1336568542 | Sheryl A Ali | Registered Nurse | 12811 Hazelton Street, Detroit, MI 48223 | 2014-04-15 |
| 1255667556 | Abyssinia Love Knot Physical Therapy LLC | Physical Medicine & Rehabilitation | 15340 Southfield Freeway, Suite 1-a, Detroit, MI 48223 | 2009-10-22 |
| 1629243902 | Glenda Faye Smith | Massage Therapist | 15041 Faust, Detroit, MI 48223 | 2008-04-28 |
| Find all providers in zip 48223 | ||||
| Taxonomy Code | 311ZA0620X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Custodial Care Facility |
| Specialization | Adult Care Home |
| A custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063028694 | Zcare | Custodial Care Facility | 8676 Auburn St, Detroit, MI 48228-2919 | 2020-09-18 |
| 1790397594 | St. Ruth's House of Hope LLC | Custodial Care Facility | 3100 S Electric St, Detroit, MI 48217-1133 | 2020-08-21 |
| 1558837229 | New Center Inn Company | Custodial Care Facility | 158 Pingree St, Detroit, MI 48202-2022 | 2018-10-19 |
| 1477029700 | Acon Services, Inc. | Custodial Care Facility | 17126 Prevost St, Detroit, MI 48235-3551 | 2018-10-14 |
| 1619452588 | Hudson Home 1 Inc | Custodial Care Facility | 750 Virginia Park St, Detroit, MI 48202-2033 | 2018-09-26 |
| 1578083077 | New Advantage Inc. | Custodial Care Facility | 15375 Ardmore St, Detroit, MI 48227-3222 | 2017-06-26 |
| 1003348145 | Reality Response LLC | Custodial Care Facility | 2455 W Grand St, Detroit, MI 48238-3445 | 2017-03-29 |
| 1225585250 | Maan Down LLC | Custodial Care Facility | 16885 Ilene St, Detroit, MI 48221 | 2016-09-07 |
| 1881051712 | Tasha Harris | Custodial Care Facility | 6402 Penrod St, Detroit, MI 48228-4748 | 2016-01-22 |
| 1619343431 | Emani Nahchelle Pippen | Custodial Care Facility | 10326 Lanark St, Detroit, MI 48224-1231 | 2015-08-16 |
| Find all providers in DETROIT | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.