Provider Demographics
NPI:1598443103
Name:K&R GLOWING PRIDE RESIDENTIAL SERVICES OF FLORIDA LLC
Entity Type:Organization
Organization Name:K&R GLOWING PRIDE RESIDENTIAL SERVICES OF FLORIDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ OPERATION OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEYANA
Authorized Official - Middle Name:
Authorized Official - Last Name:RICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-517-7688
Mailing Address - Street 1:254 S RONALD REAGAN BLVD STE 128
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-5491
Mailing Address - Country:US
Mailing Address - Phone:317-517-7688
Mailing Address - Fax:
Practice Address - Street 1:254 S RONALD REAGAN BLVD STE 128
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-5491
Practice Address - Country:US
Practice Address - Phone:317-517-7688
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-05
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care