Healthcare Provider Details

I. General information

NPI: 1932978541
Provider Name (Legal Business Name): KINGDOM CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2023
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12255 DE PAUL DR STE 445
BRIDGETON MO
63044-2513
US

IV. Provider business mailing address

12255 DE PAUL DR STE 445
BRIDGETON MO
63044-2513
US

V. Phone/Fax

Practice location:
  • Phone: 314-270-2662
  • Fax:
Mailing address:
  • Phone: 314-270-2662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: STETSON WAYNE REED
Title or Position: OWNER
Credential:
Phone: 417-584-7300