Provider Demographics
NPI:1164918215
Name:KRYSTONS HOME CARE
Entity Type:Organization
Organization Name:KRYSTONS HOME CARE
Other - Org Name:KRYSTONS HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THELMA
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-772-3452
Mailing Address - Street 1:881 W GOLDEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89506-2949
Mailing Address - Country:US
Mailing Address - Phone:775-772-3452
Mailing Address - Fax:
Practice Address - Street 1:881 W GOLDEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89506-2949
Practice Address - Country:US
Practice Address - Phone:775-772-3452
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-02
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV=========Medicaid