Provider Demographics
NPI:1134359813
Name:KONSTATIN KIYANITSA
Entity type:Organization
Organization Name:KONSTATIN KIYANITSA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KONSTATIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIYANITSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-854-4749
Mailing Address - Street 1:10 PROSPECT ST APT 63
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04092-3970
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10 PROSPECT ST APT 63
Practice Address - Street 2:
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-3970
Practice Address - Country:US
Practice Address - Phone:207-854-4749
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-16
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care