Provider Demographics
NPI:1255121307
Name:VERNELL KING ENTRPRISE LLC
Entity type:Organization
Organization Name:VERNELL KING ENTRPRISE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VERNELL
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-467-0737
Mailing Address - Street 1:1100 KINGS ROAD
Mailing Address - Street 2:UNIT 2785
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32203-2785
Mailing Address - Country:US
Mailing Address - Phone:904-467-0737
Mailing Address - Fax:
Practice Address - Street 1:1100 KINGS ROAD
Practice Address - Street 2:UNIT 2785
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32203-2785
Practice Address - Country:US
Practice Address - Phone:904-467-0737
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-12
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility