Healthcare Provider Details

I. General information

NPI: 1205971827
Provider Name (Legal Business Name): KINGDOM LIVING FACILITIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1173 KEARNEY CEMETARY RD
SNOW HILL NC
28580-8124
US

IV. Provider business mailing address

1173 KEARNEY CEMETARY RD
SNOW HILL NC
28580-8124
US

V. Phone/Fax

Practice location:
  • Phone: 252-527-7845
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberMHL-040-034
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License NumberMHL-040-034
License Number StateNC

VIII. Authorized Official

Name: MRS. JOYCE WATERS
Title or Position: DIRECTOR
Credential:
Phone: 252-527-7845