Healthcare Provider Details

I. General information

NPI: 1780254318
Provider Name (Legal Business Name): KING CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2021
Last Update Date: 05/18/2023
Certification Date: 05/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 OFFICE SQUARE LN STE 200C
VIRGINIA BEACH VA
23462-3657
US

IV. Provider business mailing address

313 OFFICE SQUARE LN STE 200C
VIRGINIA BEACH VA
23462-3657
US

V. Phone/Fax

Practice location:
  • Phone: 757-241-5076
  • Fax: 757-279-3175
Mailing address:
  • Phone: 757-241-5076
  • 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 Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DESIREE KING
Title or Position: CEO
Credential:
Phone: 757-241-5076