Provider Demographics
NPI:1811238306
Name:KINGS PERSONAL KARE FACILITY GRP LLC
Entity Type:Organization
Organization Name:KINGS PERSONAL KARE FACILITY GRP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:SPEARS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-472-3015
Mailing Address - Street 1:111 ELIZABETH WAY
Mailing Address - Street 2:
Mailing Address - City:ELLENWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30294-2820
Mailing Address - Country:US
Mailing Address - Phone:678-869-5464
Mailing Address - Fax:678-583-1496
Practice Address - Street 1:111 ELIZABETH WAY
Practice Address - Street 2:
Practice Address - City:ELLENWOOD
Practice Address - State:GA
Practice Address - Zip Code:30294-2820
Practice Address - Country:US
Practice Address - Phone:678-869-5464
Practice Address - Fax:678-583-1496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-07
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health