Provider Demographics
NPI:1578960654
Name:K & S TENDER CARE LLC
Entity Type:Organization
Organization Name:K & S TENDER CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:VACCIANNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-557-6588
Mailing Address - Street 1:1768 WINDING RIDGE CIRCLE SE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32909-1129
Mailing Address - Country:US
Mailing Address - Phone:321-557-6592
Mailing Address - Fax:321-327-3980
Practice Address - Street 1:155 AVIATION AVE NE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-3022
Practice Address - Country:US
Practice Address - Phone:321-557-6588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-04
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12956310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility