MEDICARE: KINGDOM IN HOME CARE

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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1205605870
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KINGDOM IN HOME CARE

Provider Business Mailing Address
First Line	:	12255 DE PAUL DR STE 445
Second Line	:
City	:	BRIDGETON
State	:	MO
Zip	:	63044-2513
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12255 DE PAUL DR
Second Line	:
City	:	BRIDGETON
State	:	MO
Zip	:	63044-2510
Country	:	US
Telephone Number	:	314-270-2662
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	STETSON WAYNE REED
Credential	:
Telephone Number	:	417-584-7300

Provider Enumeration Date	:	12/25/2023
Last Update Date	:	06/23/2026

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Directions to “KINGDOM IN HOME CARE ” Practice Location

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