MEDICARE: KINGDOM CONNECT GROUP HOME, 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	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility

General Provider Information

NPI Number	:	1578421368
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KINGDOM CONNECT GROUP HOME, LLC

Provider Business Mailing Address
First Line	:	2718 W PECAN RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85041-4419
Country	:	US
Telephone Number	:	602-670-0665
Fax Number	:

Provider Business Practice Location Address
First Line	:	2718 W PECAN RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85041-4419
Country	:	US
Telephone Number	:	602-670-0665
Fax Number	:

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	NINA WORKS
Credential	:
Telephone Number	:	602-670-0665

Provider Enumeration Date	:	01/12/2026
Last Update Date	:	01/12/2026

Similar Medicare Providers

1437025624 — NINA J WORKS
Practice Location Address:

2718 W PECAN RD
PHOENIX, AZ
85041-4419

Practice Phone: 602-670-0665
Practice Fax:

1356330195 — MRS. ASHLEY SUZANNE RYAN M.S., C.G.C.
Practice Location Address:

222 W THOMAS RD , SUITE 304
PHOENIX, AZ
85013-4419

Practice Phone: 602-406-4386
Practice Fax: 602-406-4363

1336112093 — PAMELA S KLONOFF PHD PLLC
Practice Location Address:

222 W THOMAS RD , SUITE 401
PHOENIX, AZ
85013-4419

Practice Phone: 602-406-3473
Practice Fax:

1770556433 — DR. PAMELA S KLONOFF PHD
Practice Location Address:

222 W THOMAS RD , SUITE 401
PHOENIX, AZ
85013-4419

Practice Phone: 602-406-3473
Practice Fax: 602-406-4406

1992774236 — DR. YARA VARGAS M.D.
Practice Location Address:

222 W THOMAS RD , STE. 212
PHOENIX, AZ
85013-4419

Practice Phone: 602-406-6304
Practice Fax: 602-406-6302

1376506683 — SCOTT F ALEXANDER M.D.
Practice Location Address:

222 W THOMAS RD , STE 102
PHOENIX, AZ
85013-4419

Practice Phone: 602-285-9550
Practice Fax: 602-234-3748

Directions to “KINGDOM CONNECT GROUP HOME, 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.