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Contact Information

CAPTIVATING CROWN LLC
1325 ROCK QUARRY RD
STOCKBRIDGE, GA30281-5088
 Phone: 770-506-4247
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Customized Equipment

332BC3200X 87 All Other Suppliers
Indicates primary specialty

NPI Profile & details for CAPTIVATING CROWN LLC

NPI Number 1770245433
LBN Legal business name CAPTIVATING CROWN LLC
Authorized official CRYSTAL KILLINGSWORTH - (OWNER)
Entity Organization
Organization subpart 1 No
Enumeration date 10/11/2021
Last updated 04/11/2022 - About 4 years ago
Identifiers
GA Medicaid 309-628398
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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