Healthcare Provider Details

I. General information

NPI: 1932860988
Provider Name (Legal Business Name): KING'S KARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2022
Last Update Date: 01/03/2022
Certification Date: 01/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1364 SIMMONS ST
DOLOMITE AL
35061-1218
US

IV. Provider business mailing address

1364 SIMMONS ST
DOLOMITE AL
35061-1218
US

V. Phone/Fax

Practice location:
  • Phone: 205-447-6854
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. DEQUARIUS KING
Title or Position: OWNER/CEO
Credential: PHD.
Phone: 205-447-6854