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General NPI Number Information
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NPI Number | 1447212915
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Entity Type | Organization
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Legal Business Name | KING STREET HOME INC
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Dates
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Enumeration Date | 04/03/2006
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Last Update Date | 11/03/2014
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Provider Practice Location Address
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Address Line | 787 KING ST
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City | RYE BROOK
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State | NY
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Zip | 10573-1225
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Country | US
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Telephone | 914-937-5800
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Fax | 914-949-6986
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Provider Business Mailing Address
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Address Line | 787 KING ST
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City | RYE BROOK
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State | NY
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Zip | 10573-1225
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Country | US
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Telephone | 914-937-5800
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Fax | 914-949-6986
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. ROBERT WILNER
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Credential |
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Telephone | 914-937-5800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 5906300N
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License Number State | NY
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