Provider Demographics
NPI:1548702608
Name:KIVA OF PALATKA
Entity type:Organization
Organization Name:KIVA OF PALATKA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RAPHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HOFFMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-325-0699
Mailing Address - Street 1:201 ZEAGLER DR
Mailing Address - Street 2:
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177-3818
Mailing Address - Country:US
Mailing Address - Phone:386-325-0699
Mailing Address - Fax:386-328-2591
Practice Address - Street 1:201 ZEAGLER DR
Practice Address - Street 2:
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-3818
Practice Address - Country:US
Practice Address - Phone:386-325-0699
Practice Address - Fax:386-328-2591
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PARAMOUNT ALF,INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-11-07
Last Update Date:2018-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL827310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility