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General NPI Number Information
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NPI Number | 1023269354
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Entity Type | Organization
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Legal Business Name | BKK SERVICE OF CENTRAL FLORIDA, INC
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Dates
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Enumeration Date | 10/06/2008
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Last Update Date | 04/17/2018
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Provider Practice Location Address
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Address Line | 902 S FLORIDA AVE SUITE 201
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City | LAKELAND
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State | FL
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Zip | 33803-1183
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Country | US
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Telephone | 863-701-9100
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Fax | 863-644-8077
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Provider Business Mailing Address
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Address Line | 902 S FLORIDA AVE SUITE 201
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City | LAKELAND
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State | FL
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Zip | 33803-1183
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Country | US
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Telephone | 863-701-9100
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Fax | 863-644-8077
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Authorized Official
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Title or Position | CEO
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Name | TRACY DEAN KELLEY
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Credential |
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Telephone | 863-701-9100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 228316
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 229362
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 230019
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 299992766
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License Number State | FL
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