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General NPI Number Information
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NPI Number | 1013345883
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Entity Type | Organization
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Legal Business Name | KIST ALF, INC
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Dates
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Enumeration Date | 10/14/2013
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Last Update Date | 10/14/2013
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Provider Practice Location Address
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Address Line | 1516 CARMEN AVENUE
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City | DAYTONA BEACH
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State | FL
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Zip | 32117
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Country | US
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Telephone | 386-239-9774
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Fax |
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Provider Business Mailing Address
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Address Line | 1516 CARMEN AVENUE
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City | DAYTONA BEACH
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State | FL
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Zip | 32117
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Country | US
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Telephone | 386-239-9774
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. SHARON KIST
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Credential |
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Telephone | 386-566-1020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AL9802
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License Number State | FL
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