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General NPI Number Information
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NPI Number | 1215757190
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Entity Type | Organization
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Legal Business Name | KINGDOM FAMILY NW
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Dates
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Enumeration Date | 10/15/2024
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Last Update Date | 03/18/2025
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Provider Practice Location Address
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Address Line | 10804 NE HIGHWAY 99
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City | VANCOUVER
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State | WA
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Zip | 98686-5655
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Country | US
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Telephone | 360-342-8622
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Fax |
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Provider Business Mailing Address
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Address Line | 821 NW 175TH WAY
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City | RIDGEFIELD
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State | WA
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Zip | 98642-6963
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Country | US
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Telephone | 360-216-9846
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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 | MR. CHOCHO FAIFAI SR.
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Credential |
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Telephone | 360-216-9846
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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