Healthcare Provider Details

I. General information

NPI: 1225781768
Provider Name (Legal Business Name): KINGDOM 1ST HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2022
Last Update Date: 10/25/2025
Certification Date: 10/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304A MAIN ST
BAYBORO NC
28515-9528
US

IV. Provider business mailing address

304A MAIN ST
BAYBORO NC
28515-9528
US

V. Phone/Fax

Practice location:
  • Phone: 252-745-9124
  • Fax: 252-745-9256
Mailing address:
  • Phone: 252-745-9224
  • Fax: 252-745-9256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: URSULA L MOORE
Title or Position: DIRECTOR/ OWNER
Credential:
Phone: 252-745-9124