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General NPI Number Information
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NPI Number | 1598443103
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Entity Type | Organization
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Legal Business Name | K&R GLOWING PRIDE RESIDENTIAL SERVICES OF FLORIDA LLC
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Dates
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Enumeration Date | 07/05/2023
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Last Update Date | 02/06/2025
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Provider Practice Location Address
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Address Line | 254 S RONALD REAGAN BLVD STE 128
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City | LONGWOOD
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State | FL
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Zip | 32750-5491
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Country | US
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Telephone | 317-517-7688
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Fax |
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Provider Business Mailing Address
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Address Line | 254 S RONALD REAGAN BLVD STE 128
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City | LONGWOOD
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State | FL
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Zip | 32750-5491
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Country | US
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Telephone | 317-517-7688
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Fax |
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Authorized Official
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Title or Position | CEO/ OPERATION OWNER
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Name | KEYANA RICE
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Credential |
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Telephone | 317-517-7688
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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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