MEDICARE: KINGDOM HOME CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1043142615
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KINGDOM HOME CARE LLC

Provider Business Mailing Address
First Line	:	12451 S 79TH AVE
Second Line	:
City	:	PAPILLION
State	:	NE
Zip	:	68046-4694
Country	:	US
Telephone Number	:	402-718-0538
Fax Number	:

Provider Business Practice Location Address
First Line	:	12451 S 79TH AVE
Second Line	:
City	:	PAPILLION
State	:	NE
Zip	:	68046-4694
Country	:	US
Telephone Number	:	402-718-0538
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ALONZO WYNNE
Credential	:
Telephone Number	:	402-718-0538

Provider Enumeration Date	:	05/29/2026
Last Update Date	:	05/29/2026

Similar Medicare Providers

1528519923 — JUSTIN ANNIN ATC
Practice Location Address:

12419 S 79TH AVE
PAPILLION, NE
68046-4694

Practice Phone: 402-991-9792
Practice Fax:

1497695696 — ALONZO E WYNNE
Practice Location Address:

12451 S 79TH AVE
PAPILLION, NE
68046-4694

Practice Phone: 402-718-0538
Practice Fax:

1386575421 — KYAW THA DAH
Practice Location Address:

11869 S 116TH ST
PAPILLION, NE
68046-5045

Practice Phone: 531-205-9945
Practice Fax:

1922930536 — JOHN MICHAEL PALMER
Practice Location Address:

425 W LINCOLN ST APT 1
PAPILLION, NE
68046-2511

Practice Phone: 806-282-4916
Practice Fax:

1821989310 — MIDWEST MIND AND BODY HEALTHCARE LLC
Practice Location Address:

131 N WASHINGTON ST STE A
PAPILLION, NE
68046-2434

Practice Phone: 531-217-5257
Practice Fax:

1952650608 — MS. KIMBERLY ANN WOHLWEND APRN, PMHNP-BC
Practice Location Address:

131 N WASHINGTON ST STE A
PAPILLION, NE
68046-2434

Practice Phone: 531-217-5257
Practice Fax: 949-864-3749

Directions to “KINGDOM HOME CARE LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.