Healthcare Provider Details

I. General information

NPI: 1730064841
Provider Name (Legal Business Name): KINGDOM BEGINNINGS BIRTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2025
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12265 FREMONT LN
ZIMMERMAN MN
55398-9318
US

IV. Provider business mailing address

12265 FREMONT LN
ZIMMERMAN MN
55398-9318
US

V. Phone/Fax

Practice location:
  • Phone: 763-600-3255
  • Fax:
Mailing address:
  • Phone: 763-600-3255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State

VIII. Authorized Official

Name: CIARA J KING
Title or Position: OWNER/FOUNDER
Credential:
Phone: 763-600-3255