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	1041C0700X	Clinical Social Worker	SW7994	FL

General Provider Information

NPI Number	:	1225173800
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. TRUDY NOVICKI
Credential	:
Telephone Number	:	305-547-6800

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	08/22/2020

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Directions to “KRISTI HOUSE, INC. ” Practice Location

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