Healthcare Provider Details

I. General information

NPI: 1124930474
Provider Name (Legal Business Name): KRISSY KRSTINE LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1033B HIGHWAY 155 N
MCDONOUGH GA
30252-5543
US

IV. Provider business mailing address

1033B HIGHWAY 155 N
MCDONOUGH GA
30252-5543
US

V. Phone/Fax

Practice location:
  • Phone: 770-270-3880
  • Fax:
Mailing address:
  • Phone: 770-270-3880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: SHARRON BROWN-WALKER
Title or Position: ADMINISTRATOR
Credential:
Phone: 718-598-5967