Provider Demographics
NPI:1952890105
Name:ROSE KIHARA NURSE PRACTITIONER LLC
Entity Type:Organization
Organization Name:ROSE KIHARA NURSE PRACTITIONER LLC
Other - Org Name:FAMILY HEALTH CARE & WALK IN CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:APRN
Authorized Official - Prefix:
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:KIHARA
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:860-315-1198
Mailing Address - Street 1:PO BOX 922
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:CT
Mailing Address - Zip Code:06281-3044
Mailing Address - Country:US
Mailing Address - Phone:860-315-1198
Mailing Address - Fax:860-315-1199
Practice Address - Street 1:39 ROUTE 171
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:CT
Practice Address - Zip Code:06281
Practice Address - Country:US
Practice Address - Phone:860-776-0187
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-03
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008023376Medicaid