MEDICARE: KALYANI SENIOR SERVICES CO.

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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1922666783
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KALYANI SENIOR SERVICES CO.

Provider Business Mailing Address
First Line	:	5421 OLD POOLE RD STE 106
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27610-3285
Country	:	US
Telephone Number	:	919-724-4297
Fax Number	:	919-724-4888

Provider Business Practice Location Address
First Line	:	5421 OLD POOLE RD STE 106
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27610-3285
Country	:	US
Telephone Number	:	919-724-4297
Fax Number	:	919-724-4888

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SANJAY DAS
Credential	:
Telephone Number	:	919-724-4297

Provider Enumeration Date	:	06/05/2019
Last Update Date	:	06/17/2020

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