MEDICARE: KINGDOM CAREGIVERS 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	261QA0600X	Adult Day Care Clinic/Center	ADC14-1103720	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154702587
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KINGDOM CAREGIVERS LLC

Provider Business Mailing Address
First Line	:	PO BOX 7872
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23231-0372
Country	:	US
Telephone Number	:	804-551-4647
Fax Number	:	804-482-2842

Provider Business Practice Location Address
First Line	:	2210 CARTER ST
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23222-2407
Country	:	US
Telephone Number	:	804-321-1016
Fax Number	:	804-321-1017

Authorized Official
Title or Position	:	RN/EXECUTIVE DIRECTOR
Name	:	MRS. ANGELISE M FRANCIS
Credential	:
Telephone Number	:	804-551-4647

Provider Enumeration Date	:	06/11/2015
Last Update Date	:	06/11/2015

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Directions to “KINGDOM CAREGIVERS LLC ” Practice Location

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