Healthcare Provider Details

I. General information

NPI: 1649065129
Provider Name (Legal Business Name): KING CIRCLE OF CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2025
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4701 N FEDERAL HWY STE 460
POMPANO BEACH FL
33064-6591
US

IV. Provider business mailing address

401 SW 1ST AVE APT 2406
FORT LAUDERDALE FL
33301-4546
US

V. Phone/Fax

Practice location:
  • Phone: 267-574-2457
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: NIKEDA STANBACK
Title or Position: OWNER
Credential: BCBA
Phone: 267-574-2457