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General NPI Number Information
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NPI Number | 1316284607
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Entity Type | Organization
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Legal Business Name | S & B KINGDOM CARE L.L.C
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Dates
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Enumeration Date | 01/07/2013
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Last Update Date | 01/07/2013
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Provider Practice Location Address
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Address Line | 10 RENN LN
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City | PALM COAST
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State | FL
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Zip | 32164-6633
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Country | US
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Telephone | 386-313-5988
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Fax | 386-313-5989
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Provider Business Mailing Address
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Address Line | 10 RENN LN
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City | PALM COAST
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State | FL
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Zip | 32164-6633
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Country | US
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Telephone | 386-313-5988
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Fax | 386-313-5989
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Authorized Official
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Title or Position | OWNER
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Name | MRS. BRENDA NOTICE
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Credential |
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Telephone | 386-334-6718
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 12302
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License Number State | FL
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