Provider Demographics
NPI:1023269354
Name:BKK SERVICE OF CENTRAL FLORIDA, INC
Entity type:Organization
Organization Name:BKK SERVICE OF CENTRAL FLORIDA, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-701-9100
Mailing Address - Street 1:902 S FLORIDA AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-1183
Mailing Address - Country:US
Mailing Address - Phone:863-701-9100
Mailing Address - Fax:863-644-8077
Practice Address - Street 1:902 S FLORIDA AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-1183
Practice Address - Country:US
Practice Address - Phone:863-701-9100
Practice Address - Fax:863-644-8077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-06
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL228316253Z00000X
FL229362253Z00000X
FL230019253Z00000X
FL299992766251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000765900Medicaid