King Street Home Inc

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

5906300N Issued in NY

Legal business name

KING STREET HOME INC

Practice address

787 King St
Rye Brook, NY 10573-1225

Phone

(914) 937-5800

Fax

(914) 949-6986

NPI assigned

Apr 3, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Robert Wilner

Title

Administrator

Phone

(914) 937-5800

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1447212915. Details of each certification follow.

• CCN 335447 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 335447

Legal name

KING STREET HOME INC

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Jul 1, 1975

Last certification

Jan 11, 2024

Beds

120

Ownership / control type

Corporation

Organization structure

CorporationProprietary

Enrollment address

787 King St
Rye Brook, NY 10573-1225

Nursing home name

KING STREET HOME INC

Listed as

King Street Home IncCCN 335447 · All quality measures

Overall star rating

2 of 5

Health inspections

2 of 5

Staffing

4 of 5

Quality measures

4 of 5

Type

Medicare and Medicaid

Ownership

For profit - Corporation

Certified

Jul 1, 1975

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

12065.2 residents per day on average

Processed by Care Compare on Aug 1, 2026.

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

CLIA laboratory certificates

All disclosed owners & managing parties 4

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Albert Riddle, MD

  • Geriatric Medicine (Internal Medicine) Physician
  • Haworth, NJ
  • NPI 1699724880

  Adp of the SNF, Operational/Managerial Control

  CMS ownership

Affiliated clinicians 5

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Osa Christopher Guobadia, MD

  • Family Medicine Physician
  • Middletown, NY
  • NPI 1306402268

  Nursing home

  Care Compare affiliation
• Philip Huh, MD

  • Hospitalist Physician
  • White Plains, NY
  • NPI 1255573341

  Nursing home

  Care Compare affiliation
• William Jacobson, MD

  • Family Medicine Physician
  • White Plains, NY
  • NPI 1801803556

  Nursing home

  Care Compare affiliation
• Jay S Mathur, DO

  • Internal Medicine Physician
  • Rye, NY
  • NPI 1609192608

  Nursing home

  Care Compare affiliation
• Roshani Ramesh Shah, MD

  • Hospitalist Physician
  • White Plains, NY
  • NPI 1255322756

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1144022400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1414972800000",
    "number": "1447212915",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "787 KING ST",
            "city": "RYE BROOK",
            "state": "NY",
            "postal_code": "105731225",
            "telephone_number": "914-937-5800",
            "fax_number": "914-949-6986"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "787 KING ST",
            "city": "RYE BROOK",
            "state": "NY",
            "postal_code": "105731225",
            "telephone_number": "914-937-5800",
            "fax_number": "914-949-6986"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KING STREET HOME INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-03",
        "last_updated": "2014-11-03",
        "status": "A",
        "authorized_official_last_name": "WILNER",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "914-937-5800",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NY",
            "license": "5906300N",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00312978",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Chris Keidong, PT
• Erin Maria Kelley I
• Barbara Ann Kenealy, RPH
• Cynthia Kenny, M.S., CCC-SLP
• F Frederic Khoury, MD
• Steven M Klein, DDS
• Andrew Young Kleinman, M.D.
• Lana Kornfeld, PT
• Mary Kosco, FNP
• Caren L Kurtz Goodman, M.D.

• Skilled Nursing Facility in Rye Brook, NY
• Providers in Rye Brook, NY by specialty
• Skilled Nursing Facility in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• 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.