Kiva of Palatka, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

AL827 Issued in FL

Legal business name

KIVA OF PALATKA, LLC

Practice address

201 Zeagler Dr
Palatka, FL 32177-3818

Phone

(386) 325-0699

NPI assigned

Oct 18, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Thomas Scarborough

Title

Owner

Phone

(615) 397-5271

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1350518400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350518400000",
    "number": "1457604241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 7TH ST",
            "city": "BONITA SPRINGS",
            "state": "FL",
            "postal_code": "341347415"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 ZEAGLER DR",
            "city": "PALATKA",
            "state": "FL",
            "postal_code": "321773818",
            "telephone_number": "386-325-0699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIVA OF PALATKA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-18",
        "last_updated": "2012-10-18",
        "status": "A",
        "authorized_official_last_name": "SCARBOROUGH",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "615-397-5271",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "AL827",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID WAIVER",
            "identifier": "689186100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jeb Kincannon, DPT
• Angela Nicole King, LMT
• Gail King, PHARM D, MBA
• Sarabeth Kirkland, SLPD, CCC-SLP
• Kiva of Palatka
• Patricia Kowalchuk, OTA/L
• Michelle Kowalski
• Janice Marie Krabbe, MD
• Ramesh Kumar, MD
• Kuruvilla Oncology, LLC

• Assisted Living Facility in Palatka, FL
• Providers in Palatka, FL by specialty
• Assisted Living Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.