Provider Demographics
NPI:1770630493
Name:K.S.T. MANAGEMENT, LLC
Entity Type:Organization
Organization Name:K.S.T. MANAGEMENT, LLC
Other - Org Name:PARK HILL ADULT HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:TEMPELBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-972-9409
Mailing Address - Street 1:52 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010-4706
Mailing Address - Country:US
Mailing Address - Phone:518-842-7813
Mailing Address - Fax:518-842-7339
Practice Address - Street 1:52 GROVE ST
Practice Address - Street 2:
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-4706
Practice Address - Country:US
Practice Address - Phone:518-842-7813
Practice Address - Fax:518-842-7339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1248A001251E00000X
NY1248L001251E00000X
NY380-F-045310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251E00000XAgenciesHome Health
Not Answered310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02205021Medicaid
NY02647785Medicaid