Provider Demographics
NPI:1386340495
Name:KRISE HEALTH SERVICES LLC
Entity type:Organization
Organization Name:KRISE HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:CHINYERE
Authorized Official - Middle Name:
Authorized Official - Last Name:UBAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-213-5494
Mailing Address - Street 1:127 QUIET RD
Mailing Address - Street 2:
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-5628
Mailing Address - Country:US
Mailing Address - Phone:609-248-0155
Mailing Address - Fax:
Practice Address - Street 1:4 HADDONFIELD RD STE 222
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-1467
Practice Address - Country:US
Practice Address - Phone:215-313-1989
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-01
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)