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NPI Code Detail

MEDICARE: KING STREET HOME INC

MEDICARE: KING STREET HOME INC
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
1314000000XSkilled Nursing Facility5906300NNY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1447212915
Entity Type Code : Organization
Provider Name (Legal Business Name) : KING STREET HOME INC
Provider Business Mailing Address
First Line : 787 KING ST
Second Line :
City : RYE BROOK
State : NY
Zip : 10573-1225
Country : US
Telephone Number : 914-937-5800
Fax Number : 914-949-6986
Provider Business Practice Location Address
First Line : 787 KING ST
Second Line :
City : RYE BROOK
State : NY
Zip : 10573-1225
Country : US
Telephone Number : 914-937-5800
Fax Number : 914-949-6986
Authorized Official
Title or Position : ADMINISTRATOR
Name : MR. ROBERT WILNER
Credential :
Telephone Number : 914-937-5800
Provider Enumeration Date : 04/03/2006
Last Update Date : 11/03/2014

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Directions to “KING STREET HOME INC ” Practice Location

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