Provider Demographics
NPI:1568803690
Name:THE KING'S PALACE LLC
Entity Type:Organization
Organization Name:THE KING'S PALACE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MYRNA
Authorized Official - Middle Name:
Authorized Official - Last Name:PERRIER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:407-272-5141
Mailing Address - Street 1:2291 ALTON RD
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32738-4001
Mailing Address - Country:US
Mailing Address - Phone:386-218-5767
Mailing Address - Fax:386-218-3058
Practice Address - Street 1:2291 ALTON RD
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32738-4001
Practice Address - Country:US
Practice Address - Phone:386-218-5767
Practice Address - Fax:386-218-3058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-17
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental DisabilitiesGroup - Multi-Specialty
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite Care