Provider Demographics
NPI:1568567469
Name:KRIECK ENTERPRISES LLC
Entity Type:Organization
Organization Name:KRIECK ENTERPRISES LLC
Other - Org Name:HOMECARE AMERICA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:KRIECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-377-8990
Mailing Address - Street 1:125 PARK AVENUE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07940-1122
Mailing Address - Country:US
Mailing Address - Phone:973-377-8990
Mailing Address - Fax:973-377-8995
Practice Address - Street 1:125 PARK AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:NJ
Practice Address - Zip Code:07940-1122
Practice Address - Country:US
Practice Address - Phone:973-377-8990
Practice Address - Fax:973-377-8995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0045110Medicaid
NJ1003788OtherPROGRESSIVE
NJ0045110Medicaid
NJ0045110Medicaid