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General NPI Number Information
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NPI Number | 1114484136
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Entity Type | Organization
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Legal Business Name | KINGDOM CARE LIVING HOMEMAKER AND COMPANION SERVICES, LLC
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Dates
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Enumeration Date | 02/26/2019
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Last Update Date | 10/02/2019
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Provider Practice Location Address
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Address Line | 823 MOSSWOOD CHASE ST
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City | ORANGE PARK
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State | FL
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Zip | 32065-5541
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Country | US
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Telephone | 954-464-5784
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Fax |
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Provider Business Mailing Address
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Address Line | 823 MOSSWOOD CHASE ST
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City | ORANGE PARK
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State | FL
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Zip | 32065-5541
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Country | US
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Telephone | 954-464-5784
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Fax |
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Authorized Official
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Title or Position | CEO/ADMINISTRATOR
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Name | DR. NAKITIA JACKSON
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Credential | APRN-BC
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Telephone | 954-464-5784
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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