MEDICARE: KINGDOM KARES HEALTH AND WELLNESS SERVICES, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	253Z00000X	In Home Supportive Care Agency
2	372600000X	Adult Companion
3	3747P1801X	Personal Care Attendant
4	376J00000X	Homemaker
5	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1477380418
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KINGDOM KARES HEALTH AND WELLNESS SERVICES, LLC

Provider Business Mailing Address
First Line	:	3160 HIGHWAY 21 STE 103
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29715-8888
Country	:	US
Telephone Number	:	704-249-4709
Fax Number	:

Provider Business Practice Location Address
First Line	:	3160 HIGHWAY 21 STE 103
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29715-8888
Country	:	US
Telephone Number	:	704-249-4709
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. SONYA N. SIMON
Credential	:
Telephone Number	:	704-249-4709

Provider Enumeration Date	:	09/16/2024
Last Update Date	:	09/16/2024

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