Provider Demographics
NPI:1366873689
Name:KINGSEAL LLC
Entity type:Organization
Organization Name:KINGSEAL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:BADENHORST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-210-3238
Mailing Address - Street 1:475 NURSING HOME DR
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:FL
Mailing Address - Zip Code:34266-3839
Mailing Address - Country:US
Mailing Address - Phone:863-494-5766
Mailing Address - Fax:863-494-9470
Practice Address - Street 1:475 NURSING HOME DR
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:FL
Practice Address - Zip Code:34266-3839
Practice Address - Country:US
Practice Address - Phone:863-494-5766
Practice Address - Fax:863-494-9470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-12
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
1043266497Medicare Oscar/Certification
FL1043266497Medicare Oscar/Certification