Provider Demographics
NPI:1700612181
Name:KITES, KRIS S (FOSTER HOME OWNER)
Entity type:Individual
Prefix:
First Name:KRIS
Middle Name:S
Last Name:KITES
Suffix:
Gender:M
Credentials:FOSTER HOME OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 24TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97322-5531
Mailing Address - Country:US
Mailing Address - Phone:541-791-7711
Mailing Address - Fax:
Practice Address - Street 1:1115 24TH AVE SE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97322-5531
Practice Address - Country:US
Practice Address - Phone:541-791-7711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR530063372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion