Healthcare Provider Details

I. General information

NPI: 1295535243
Provider Name (Legal Business Name): K.I.S.H. HOME INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2025
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 HIAWATHA LN
DOVER DE
19904-2486
US

IV. Provider business mailing address

PO BOX 672
FELTON DE
19943-0672
US

V. Phone/Fax

Practice location:
  • Phone: 302-241-2172
  • Fax:
Mailing address:
  • Phone: 302-399-6477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: KISHMA GEORGE
Title or Position: PRESIDENT
Credential:
Phone: 302-399-6477