Healthcare Provider Details

I. General information

NPI: 1619643350
Provider Name (Legal Business Name): KING PREMIER CARE SERVICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2021
Last Update Date: 09/01/2021
Certification Date: 09/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2169 WINTERMERE POINTE DR
WINTER GARDEN FL
34787-5439
US

IV. Provider business mailing address

2169 WINTERMERE POINTE DR
WINTER GARDEN FL
34787-5439
US

V. Phone/Fax

Practice location:
  • Phone: 407-592-0630
  • Fax:
Mailing address:
  • Phone: 407-592-0630
  • 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: MR. FRANKIE SOLOMON
Title or Position: PRESIDENT
Credential:
Phone: 407-592-0630