=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063221737
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KR DEVELOPMENTAL SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/06/2025
-----------------------------------------------------
Last Update Date | 04/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2 ROWAN DRIVE
-----------------------------------------------------
City | GARNERVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10923
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-341-1401
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2 ROWAN DRIVE
-----------------------------------------------------
City | GARNERVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10923
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-341-1401
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILINGUAL SPECIAL INSTRUCTOR
-----------------------------------------------------
Name | KARINA RIVAS
-----------------------------------------------------
Credential | MS. SPED
-----------------------------------------------------
Telephone | 646-341-1401
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------