Organization
KALEB'S ROOM LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LASHANDER SIMMONS LPN (OWNER)
(904) 649-2985
Entity
Organization
Contact information
Practice address
12172 HAYDEN LAKES CIR, JACKSONVILLE, FL 32218-9068
(904) 649-2985
(904) 934-1012
Mailing address
9428 BAYMEADOWS RD STE 502, JACKSONVILLE, FL 32256-7973
(904) 649-2985
(904) 934-1012
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
—
—
3747P1801X
Personal Care Attendant
Primary
—
—
385H00000X
Respite Care
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
127940800
—
FL
Enumeration date
09/30/2025
Last updated
09/30/2025
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