Kre Husky Waltham Licensee LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

KRE HUSKY WALTHAM LICENSEE LLC

Practice address

126 Smith St
Waltham, MA 02451-1300

Phone

(781) 609-7996

NPI assigned

May 29, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Thomas H. Grape

Title

President

Phone

(781) 489-7100

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1559088000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1559088000000",
    "number": "1013575752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 JONES RD FL 3",
            "city": "WALTHAM",
            "state": "MA",
            "postal_code": "024511600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "126 SMITH ST",
            "city": "WALTHAM",
            "state": "MA",
            "postal_code": "024511300",
            "telephone_number": "781-609-7996"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KRE HUSKY WALTHAM LICENSEE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-29",
        "last_updated": "2019-05-29",
        "status": "A",
        "authorized_official_last_name": "GRAPE",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "H.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "781-489-7100",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gary L Kracoff, REG. PHARM, NMD
• Nadine Kraman, LMHC
• Amy Krasner, LICSW
• Tina Z. Kraus, LICSW
• Robin Krawczyk
• Kre-BSL Husky Waltham Operations LLC
• Bethany Lena Kregiel
• Andrea Kremer, LMHC
• Amy Krentzman, LICSW
• Mallory Kroll

• Assisted Living Facility in Waltham, MA
• Providers in Waltham, MA by specialty
• Assisted Living Facility in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.