Healthcare Provider Details

I. General information

NPI: 1184505554
Provider Name (Legal Business Name): KINGDOM CARE BUSINESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2025
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3031 SCOTSMAN RD STE 15
COLUMBIA SC
29223-1812
US

IV. Provider business mailing address

3031 SCOTSMAN RD STE 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 TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State

VIII. Authorized Official

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