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General NPI Number Information
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NPI Number | 1851998256
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Entity Type | Organization
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Legal Business Name | MISS K'S ENRICHMENT CENTER INC DBA CAMPBELL'S LANDING ASSISTED LIVING
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Dates
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Enumeration Date | 10/08/2020
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Last Update Date | 10/08/2020
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Provider Practice Location Address
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Address Line | 904 LAKE MARTHA DR NE
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City | WINTER HAVEN
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State | FL
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Zip | 33881-4278
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Country | US
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Telephone | 863-207-1743
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Fax | 863-875-8023
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Provider Business Mailing Address
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Address Line | 904 LAKE MARTHA DR NE
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City | WINTER HAVEN
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State | FL
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Zip | 33881-4278
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Country | US
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Telephone | 863-207-1743
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Fax | 863-875-8023
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MISS KATINA L CAMPBELL
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Credential | LPN
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Telephone | 863-207-1743
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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 |
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License Number State |
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