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General NPI Number Information
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NPI Number | 1023576964
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Entity Type | Organization
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Legal Business Name | KINGDOM GIRLS
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Dates
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Enumeration Date | 03/11/2019
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Last Update Date | 03/11/2019
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Provider Practice Location Address
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Address Line | 1401 W ESPLANADE AVE
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City | KENNER
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State | LA
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Zip | 70065-2845
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Country | US
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Telephone | 985-250-0385
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 10102
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City | NEW ORLEANS
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State | LA
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Zip | 70181-0102
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Country | US
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Telephone | 504-577-8791
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. DERRICKA MARIE GRIFFIN
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Credential |
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Telephone | 504-577-8791
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State |
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