Healthcare Provider Details

I. General information

NPI: 1154806883
Provider Name (Legal Business Name): KJ KARING GIFTS OF LIFE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2018
Last Update Date: 05/23/2021
Certification Date: 05/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 SUSAN DR
LAKELAND FL
33803-1910
US

IV. Provider business mailing address

920 SUSAN DR
LAKELAND FL
33803-1910
US

V. Phone/Fax

Practice location:
  • Phone: 863-940-7251
  • 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 State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. GENEVIEVE PEAKER
Title or Position: OWNER
Credential:
Phone: 863-940-7251