Provider Demographics
NPI:1285940353
Name:KINGDOM KARE FOR THE ELDERLY
Entity type:Organization
Organization Name:KINGDOM KARE FOR THE ELDERLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LUNDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-321-6365
Mailing Address - Street 1:PO BOX 225
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32772-0225
Mailing Address - Country:US
Mailing Address - Phone:407-321-6365
Mailing Address - Fax:407-321-6225
Practice Address - Street 1:357 CONCH KEY WAY
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-5219
Practice Address - Country:US
Practice Address - Phone:407-321-6365
Practice Address - Fax:407-321-6225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-26
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL09000020824253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care