Provider Demographics
NPI:1073840658
Name:RUSSELL KROL ENTERPRISES, INC.
Entity Type:Organization
Organization Name:RUSSELL KROL ENTERPRISES, INC.
Other - Org Name:HOME INSTEAD SENIOR CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:KROL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-799-1400
Mailing Address - Street 1:1799 N BELCHER RD
Mailing Address - Street 2:STE B
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-1324
Mailing Address - Country:US
Mailing Address - Phone:727-799-1400
Mailing Address - Fax:727-799-3958
Practice Address - Street 1:1799 N BELCHER RD
Practice Address - Street 2:STE B
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-1324
Practice Address - Country:US
Practice Address - Phone:727-799-1400
Practice Address - Fax:727-799-3958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-03
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ229862253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL687926800Medicaid