Provider Demographics
NPI:1801194485
Name:KRISVIC HEALTH CARE CORPORATION
Entity Type:Organization
Organization Name:KRISVIC HEALTH CARE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:I
Authorized Official - Last Name:VILLAROSA
Authorized Official - Suffix:JR
Authorized Official - Credentials:RN
Authorized Official - Phone:219-663-4858
Mailing Address - Street 1:1317 NAPA CT
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-2529
Mailing Address - Country:US
Mailing Address - Phone:219-663-4858
Mailing Address - Fax:
Practice Address - Street 1:1317 NAPA CT
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-2529
Practice Address - Country:US
Practice Address - Phone:219-663-4858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-07
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health