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General NPI Number Information
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NPI Number | 1316653025
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Entity Type | Organization
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Legal Business Name | KINGDOM HEALTHCARE SERVICES
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Dates
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Enumeration Date | 01/25/2023
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Last Update Date | 02/25/2023
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Provider Practice Location Address
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Address Line | 100 NE 15TH ST STE 205
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City | HOMESTEAD
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State | FL
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Zip | 33030-4577
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Country | US
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Telephone | 786-693-2719
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Fax | 786-789-5406
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Provider Business Mailing Address
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Address Line | 100 NE 15TH ST STE 205
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City | HOMESTEAD
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State | FL
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Zip | 33030-4577
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Country | US
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Telephone | 786-309-2045
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Fax | 786-789-5406
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Authorized Official
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Title or Position | OWNER
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Name | KETLY ANGOMA
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Credential | APRN
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Telephone | 314-620-6002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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