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General NPI Number Information
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NPI Number | 1215038005
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Entity Type | Organization
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Legal Business Name | KC GUARDIAN,INC.
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5443 PEBBLE BEACH DR
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City | LAKELAND
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State | FL
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Zip | 33813-1216
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Country | US
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Telephone | 863-644-7696
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Fax | 863-644-4666
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Provider Business Mailing Address
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Address Line | PO BOX 7298
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City | LAKELAND
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State | FL
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Zip | 33807-7298
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Country | US
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Telephone | 863-602-2935
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Fax | 863-644-4666
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Authorized Official
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Title or Position | PRESIDENT
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Name | KAREN KONOPNICKI CHAPPELL
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Credential |
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Telephone | 863-602-2935
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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