Provider Demographics
NPI:1093267718
Name:KRIS AGENCY & HOME CARE INC.
Entity Type:Organization
Organization Name:KRIS AGENCY & HOME CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MAHADAI
Authorized Official - Middle Name:
Authorized Official - Last Name:DEOKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-262-9009
Mailing Address - Street 1:16914 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-4435
Mailing Address - Country:US
Mailing Address - Phone:718-262-9009
Mailing Address - Fax:718-262-8213
Practice Address - Street 1:16914 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-4435
Practice Address - Country:US
Practice Address - Phone:718-262-9009
Practice Address - Fax:718-262-8213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-28
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY9220L001252Y00000X, 310400000X, 310500000X, 311Z00000X, 311ZA0620X, 314000000X, 3140N1450X, 315D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness
No311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric
No315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01287916Medicaid