Provider Demographics
NPI:1164250304
Name:CREST HOME CARE LLC
Entity type:Organization
Organization Name:CREST HOME CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO/BRANCH MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEEPIKA
Authorized Official - Middle Name:KUBERAN
Authorized Official - Last Name:MUDALIAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-864-7371
Mailing Address - Street 1:1600 AIRPORT FWY STE 200
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76022-6881
Mailing Address - Country:US
Mailing Address - Phone:703-864-7371
Mailing Address - Fax:
Practice Address - Street 1:1600 AIRPORT FWY STE 200
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-6881
Practice Address - Country:US
Practice Address - Phone:703-864-7371
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-22
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health