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General NPI Number Information
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NPI Number | 1649065129
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Entity Type | Organization
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Legal Business Name | KING CIRCLE OF CARE
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Dates
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Enumeration Date | 04/14/2025
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Last Update Date | 04/14/2025
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Provider Practice Location Address
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Address Line | 4701 N FEDERAL HWY STE 460
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City | POMPANO BEACH
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State | FL
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Zip | 33064-6591
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Country | US
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Telephone | 267-574-2457
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Fax |
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Provider Business Mailing Address
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Address Line | 401 SW 1ST AVE APT 2406
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City | FORT LAUDERDALE
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State | FL
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Zip | 33301-4546
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NIKEDA STANBACK
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Credential | BCBA
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Telephone | 267-574-2457
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health 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 | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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