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General NPI Number Information
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NPI Number | 1255799441
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Entity Type | Organization
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Legal Business Name | KATHLEEN BEATRICE KING SERVICES INC
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Dates
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Enumeration Date | 02/03/2016
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Last Update Date | 07/25/2016
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Provider Practice Location Address
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Address Line | 20340 NW 29TH CT
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City | MIAMI GARDENS
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State | FL
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Zip | 33056-1903
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Country | US
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Telephone | 305-305-2326
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Fax |
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Provider Business Mailing Address
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Address Line | 20340 NW 29TH CT
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City | MIAMI GARDENS
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State | FL
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Zip | 33056-1903
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Country | US
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Telephone | 305-305-2326
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. CHERYL J WATERMAN
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Credential | LCSW, PH.D
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Telephone | 305-305-2326
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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 | SW 13403
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 251300000X
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Taxonomy Name | Local Education Agency (LEA)
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License Number | SW 13403
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | SW 13403
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | SW 13403
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License Number State | FL
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