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General NPI Number Information
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NPI Number | 1013238740
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Entity Type | Organization
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Legal Business Name | KINGDOM BUILDING SERVICES LLC
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Dates
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Enumeration Date | 06/16/2010
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Last Update Date | 09/09/2011
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Provider Practice Location Address
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Address Line | 833 WILLOW RUN ST SUITE A
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City | MINNEOLA
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State | FL
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Zip | 34715
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Country | US
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Telephone | 352-678-8554
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Fax |
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Provider Business Mailing Address
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Address Line | 833 WILLOW RUN ST SUITE A
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City | MINNEOLA
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State | FL
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Zip | 34715-5768
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Country | US
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Telephone | 407-347-8204
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GRISSELLE IVETTE SIMPSON
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Credential | REV
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Telephone | 352-678-8554
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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