Healthcare Provider Details

I. General information

NPI: 1831815786
Provider Name (Legal Business Name): KINGDOM CAUSES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2022
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4508 ATLANTIC AVE STE 292
LONG BEACH CA
90807-1520
US

IV. Provider business mailing address

4508 ATLANTIC AVE STE 292
LONG BEACH CA
90807-1520
US

V. Phone/Fax

Practice location:
  • Phone: 805-722-4900
  • Fax:
Mailing address:
  • Phone: 805-722-4900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State

VIII. Authorized Official

Name: BRAD FIELDHOUSE
Title or Position: PRESIDENT
Credential:
Phone: 714-904-0167