Healthcare Provider Details

I. General information

NPI: 1902604457
Provider Name (Legal Business Name): NEW KINGDOM LIVING FOUNDATION CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 POST OAK DR
DAVENPORT FL
33837-8515
US

IV. Provider business mailing address

1819 BRENTWOOD CT
DAVENPORT FL
33837-1795
US

V. Phone/Fax

Practice location:
  • Phone: 267-774-1625
  • Fax:
Mailing address:
  • Phone: 267-774-1625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JASMINE WARDLAW
Title or Position: CEO
Credential:
Phone: 321-443-6351