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General NPI Number Information
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NPI Number | 1144194630
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Entity Type | Organization
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Legal Business Name | KALEB'S ROOM LLC
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Dates
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Enumeration Date | 09/30/2025
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Last Update Date | 09/30/2025
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Provider Practice Location Address
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Address Line | 12172 HAYDEN LAKES CIR
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City | JACKSONVILLE
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State | FL
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Zip | 32218-9068
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Country | US
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Telephone | 904-649-2985
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Fax | 904-934-1012
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Provider Business Mailing Address
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Address Line | 9428 BAYMEADOWS RD STE 502
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City | JACKSONVILLE
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State | FL
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Zip | 32256-7973
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Country | US
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Telephone | 904-649-2985
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Fax | 904-934-1012
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Authorized Official
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Title or Position | OWNER
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Name | LASHANDER SIMMONS
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Credential | LPN
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Telephone | 904-649-2985
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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 | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number |
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License Number State |
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