Provider Demographics
NPI:1225173800
Name:KRISTI HOUSE, INC.
Entity Type:Organization
Organization Name:KRISTI HOUSE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TRUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:NOVICKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-547-6800
Mailing Address - Street 1:1265 NW 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-2140
Mailing Address - Country:US
Mailing Address - Phone:305-547-6800
Mailing Address - Fax:305-547-6848
Practice Address - Street 1:1265 NW 12TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-2140
Practice Address - Country:US
Practice Address - Phone:305-547-6800
Practice Address - Fax:305-547-6848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW79941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty