Provider Demographics
NPI:1851998256
Name:MISS K'S ENRICHMENT CENTER INC DBA CAMPBELL'S LANDING ASSISTED LIVING
Entity Type:Organization
Organization Name:MISS K'S ENRICHMENT CENTER INC DBA CAMPBELL'S LANDING ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:KATINA
Authorized Official - Middle Name:L
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:863-207-1743
Mailing Address - Street 1:904 LAKE MARTHA DR NE
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-4278
Mailing Address - Country:US
Mailing Address - Phone:863-207-1743
Mailing Address - Fax:863-875-8023
Practice Address - Street 1:904 LAKE MARTHA DR NE
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-4278
Practice Address - Country:US
Practice Address - Phone:863-207-1743
Practice Address - Fax:863-875-8023
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MISS K'S ENRICHMENT CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-10-08
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL107695000Medicaid