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General NPI Number Information
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NPI Number | 1063390458
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Entity Type | Organization
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Legal Business Name | KINGDOM CARE ALTERNATIVE FAMILY LIVING LLC
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Dates
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Enumeration Date | 08/25/2025
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Last Update Date | 08/25/2025
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Provider Practice Location Address
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Address Line | 204 E ARLINGTON BLVD STE C
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City | GREENVILLE
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State | NC
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Zip | 27858-5022
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Country | US
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Telephone | 252-814-0908
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Fax |
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Provider Business Mailing Address
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Address Line | 2224 BELLAMY CIR APT 111
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City | GREENVILLE
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State | NC
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Zip | 27858-7260
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Country | US
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Telephone | 252-814-0908
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | KALYNN BLOW
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Credential | BS,QP
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Telephone | 252-814-0908
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training 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 | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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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 #4
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Taxonomy Code | 261QA0005X
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Taxonomy Name | Ambulatory Family Planning Facility
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 385HR2050X
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Taxonomy Name | Respite Care Camp
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 385HR2065X
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Taxonomy Name | Child Physical Disabilities Respite Care
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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