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General NPI Number Information
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NPI Number | 1477677813
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Entity Type | Organization
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Legal Business Name | KINGDOM HOME CARE
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 09/02/2009
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Provider Practice Location Address
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Address Line | 1530 EVANS ST STE 211
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City | GREENVILLE
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State | NC
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Zip | 27834-5301
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Country | US
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Telephone | 252-353-5522
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Fax | 252-353-5330
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Provider Business Mailing Address
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Address Line | 1530 EVANS ST STE 211
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City | GREENVILLE
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State | NC
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Zip | 27834-5301
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Country | US
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Telephone | 252-353-5522
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Fax | 252-353-5330
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Authorized Official
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Title or Position | AGENCY DIRECTOR
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Name | MS. JACQUELINE E HANSLEY
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Credential |
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Telephone | 252-353-5522
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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 | HC3221
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License Number State | NC
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