MEDICARE: KRISTI HOUSE, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205814308
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KRISTI HOUSE, INC

Provider Business Mailing Address
First Line	:	1265 NW 12TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33136-2140
Country	:	US
Telephone Number	:	305-547-6800
Fax Number	:	305-547-6848

Provider Business Practice Location Address
First Line	:	1265 NW 12TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33136-2140
Country	:	US
Telephone Number	:	305-547-6800
Fax Number	:	305-547-6848

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. CLAUDIA KITCHENS
Credential	:
Telephone Number	:	305-547-6836

Provider Enumeration Date	:	01/09/2006
Last Update Date	:	02/24/2016

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Directions to “KRISTI HOUSE, INC ” Practice Location

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