Healthcare Provider Details

I. General information

NPI: 1366873689
Provider Name (Legal Business Name): KINGSEAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2013
Last Update Date: 12/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 NURSING HOME DR
ARCADIA FL
34266-3839
US

IV. Provider business mailing address

475 NURSING HOME DR
ARCADIA FL
34266-3839
US

V. Phone/Fax

Practice location:
  • Phone: 863-494-5766
  • Fax: 863-494-9470
Mailing address:
  • Phone: 863-494-5766
  • Fax: 863-494-9470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateFL

VIII. Authorized Official

Name: MR. LOUIS DANIEL BADENHORST
Title or Position: CFO
Credential:
Phone: 813-210-3238