Provider Demographics
NPI:1083020358
Name:K AND D CARE COMMUNITIES, LLC
Entity Type:Organization
Organization Name:K AND D CARE COMMUNITIES, LLC
Other - Org Name:EVERGREEN MANOR RETIREMENT HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:D
Authorized Official - Middle Name:A
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-742-9758
Mailing Address - Street 1:3297 STATE ROAD 580
Mailing Address - Street 2:
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695-4929
Mailing Address - Country:US
Mailing Address - Phone:727-724-3776
Mailing Address - Fax:727-723-1652
Practice Address - Street 1:3297 STATE ROAD 580
Practice Address - Street 2:
Practice Address - City:SAFETY HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34695-4929
Practice Address - Country:US
Practice Address - Phone:727-724-3776
Practice Address - Fax:727-723-1652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-08
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility