Healthcare Provider Details

I. General information

NPI: 1407736978
Provider Name (Legal Business Name): KINGDOM CARE BUSINESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2025
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3031 SCOTSMAN RD # 15
COLUMBIA SC
29223-1812
US

IV. Provider business mailing address

3031 SCOTSMAN RD # 15
COLUMBIA SC
29223-1812
US

V. Phone/Fax

Practice location:
  • Phone: 803-233-4120
  • Fax:
Mailing address:
  • Phone: 803-233-4120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: JEWEL SMITH
Title or Position: OWNER
Credential:
Phone: 803-233-4120