Healthcare Provider Details

I. General information

NPI: 1093096547
Provider Name (Legal Business Name): KINGS CARE CENTERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2011
Last Update Date: 08/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

249 DESIGN PT
TOCCOA GA
30577-7904
US

IV. Provider business mailing address

249 DESIGN PT
TOCCOA GA
30577-7904
US

V. Phone/Fax

Practice location:
  • Phone: 706-391-6966
  • Fax: 706-391-6350
Mailing address:
  • Phone: 706-391-6966
  • Fax: 706-391-6350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateGA

VIII. Authorized Official

Name: MS. GAIL MURRAY
Title or Position: ADMINISTRATOR
Credential:
Phone: 706-391-6966