Provider Demographics
NPI:1104380625
Name:KRYSELLA TRISMEO CORPORATION
Entity Type:Organization
Organization Name:KRYSELLA TRISMEO CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHERYLL
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRANDA-SUNGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-243-8889
Mailing Address - Street 1:130 VALE ST
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94014-2516
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:130 VALE ST
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94014-2516
Practice Address - Country:US
Practice Address - Phone:650-755-0411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KRYSELLA TRISMEO CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-01-29
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility