Provider Demographics
NPI:1316284607
Name:S & B KINGDOM CARE L.L.C
Entity type:Organization
Organization Name:S & B KINGDOM CARE L.L.C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:NOTICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-334-6718
Mailing Address - Street 1:10 RENN LN
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-6633
Mailing Address - Country:US
Mailing Address - Phone:386-313-5988
Mailing Address - Fax:386-313-5989
Practice Address - Street 1:10 RENN LN
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-6633
Practice Address - Country:US
Practice Address - Phone:386-313-5988
Practice Address - Fax:386-313-5989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-07
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12302310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility