Provider Demographics
NPI:1871346395
Name:KYI'S PLACE RESIDENTIAL, INC.
Entity type:Organization
Organization Name:KYI'S PLACE RESIDENTIAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHEIF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:APPOLONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEPPARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-315-1591
Mailing Address - Street 1:120 CARL BAILEY RD
Mailing Address - Street 2:
Mailing Address - City:WALPOLE
Mailing Address - State:ME
Mailing Address - Zip Code:04573-3335
Mailing Address - Country:US
Mailing Address - Phone:207-315-1591
Mailing Address - Fax:
Practice Address - Street 1:120 CARL BAILEY RD
Practice Address - Street 2:
Practice Address - City:WALPOLE
Practice Address - State:ME
Practice Address - Zip Code:04573-3335
Practice Address - Country:US
Practice Address - Phone:207-315-1591
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-08
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health