MEDICARE: KIMBERLY BLACK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	311ZA0620X	Adult Care Home Facility	6906527	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144663261
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIMBERLY BLACK

Provider Business Mailing Address
First Line	:	3794 VICTORIA RD
Second Line	:
City	:	WEST PALM BCH
State	:	FL
Zip	:	33411-6440
Country	:	US
Telephone Number	:	561-629-5067
Fax Number	:

Provider Business Practice Location Address
First Line	:	3794 VICTORIA RD
Second Line	:
City	:	WEST PALM BCH
State	:	FL
Zip	:	33411-6440
Country	:	US
Telephone Number	:	561-629-5067
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	KIMBERLY BLACK
Credential	:
Telephone Number	:	561-629-5067

Provider Enumeration Date	:	04/08/2013
Last Update Date	:	12/01/2014

Similar Medicare Providers

1497832083 — DR. LYSA CHARLES MD
Practice Location Address:

2101 E JEFFERSON ST PPQA MEDICARE COMPLIANCE UNT 6 WEST , KAISER PERMANENTE MID ATLANTIC PERMANENTE MEDICAL GROUP
ROCKVILLE, MD
20852-4908

Practice Phone: 301-816-6660
Practice Fax: 301-816-6308

1306244488 — HAIR'UM IN MOTION
Practice Location Address:

3794 VICTORIA RD
WEST PALM BCH, FL
33411-6440

Practice Phone: 561-629-5067
Practice Fax:

1962095620 — DR. KEYSHA BRYANT PHARMD
Practice Location Address:

3826 VICTORIA RD
WEST PALM BEACH, FL
33411-6440

Practice Phone: 561-729-6031
Practice Fax:

1003070616 — DR. JASON NATHANIEL ROE PHARMD
Practice Location Address:

6901 OKEECHOBEE BLVD
WEST PALM BCH, FL
33411-2511

Practice Phone: 561-683-6966
Practice Fax: 561-683-6966

1205436318 — CECE MOBILE CLINIC LLC
Practice Location Address:

1323 PEBBLE RIDGE LN
WEST PALM BCH, FL
33411-6612

Practice Phone: 561-386-9229
Practice Fax: 561-366-7574

1437879228 — INFUCARE RX, LLC
Practice Location Address:

1959 W 9TH ST STE A
WEST PALM BEACH, FL
33404-6440

Practice Phone: 877-828-3940
Practice Fax:

Directions to “KIMBERLY BLACK ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.