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General NPI Number Information
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NPI Number | 1659203347
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Entity Type | Organization
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Legal Business Name | KINGDOM REST CENTER LLC
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Dates
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Enumeration Date | 05/29/2026
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Last Update Date | 05/29/2026
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Provider Practice Location Address
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Address Line | 5252 KIMBALL AVE SE
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City | KENTWOOD
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State | MI
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Zip | 49508-6147
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Country | US
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Telephone | 616-323-4379
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Fax | 616-570-0944
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Provider Business Mailing Address
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Address Line | 5252 KIMBALL AVE SE
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City | KENTWOOD
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State | MI
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Zip | 49508-6147
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Country | US
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Telephone | 616-323-4379
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Fax | 616-570-0944
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Authorized Official
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Title or Position | LICENSEE/ CEO
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Name | STEPHEN V FORKPAH
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Credential | LICENSEE
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Telephone | 616-323-4379
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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