Provider Demographics
NPI:1336293588
Name:KRIS AGECNY & HOME CARE INC
Entity Type:Organization
Organization Name:KRIS AGECNY & HOME CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MAHADAI
Authorized Official - Middle Name:
Authorized Official - Last Name:DEOKIE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:718-262-9009
Mailing Address - Street 1:16914 HILLSIDE AVE
Mailing Address - Street 2:JAMAICA
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:JAMAICA
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:2007-01-23
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY9220L001251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health