Provider Demographics
NPI:1821438953
Name:KRYSTAL BITTAR LLC
Entity Type:Organization
Organization Name:KRYSTAL BITTAR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:BITTAR
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:305-919-8099
Mailing Address - Street 1:2622 SW 32ND CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-2804
Mailing Address - Country:US
Mailing Address - Phone:305-951-1116
Mailing Address - Fax:
Practice Address - Street 1:2622 SW 32ND CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-2804
Practice Address - Country:US
Practice Address - Phone:305-951-1116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-03
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8352314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility