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General NPI Number Information
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NPI Number | 1750904314
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Entity Type | Organization
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Legal Business Name | KINGDOM BEHAVIORAL HEALTH LLC
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Dates
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Enumeration Date | 05/18/2020
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Last Update Date | 06/03/2020
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Provider Practice Location Address
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Address Line | 5 PUBLIC SQ STE 213
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City | HAGERSTOWN
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State | MD
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Zip | 21740-5599
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Country | US
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Telephone | 240-284-4641
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Fax | 240-284-4671
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Provider Business Mailing Address
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Address Line | 5 PUBLIC SQ STE 213
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City | HAGERSTOWN
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State | MD
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Zip | 21740-5599
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Country | US
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Telephone | 240-284-4641
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Fax | 240-284-4671
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Authorized Official
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Title or Position | PRESISENT/ CEO
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Name | MR. TAOFEEK BELLO
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Credential | NURSE PRACTITIONER
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Telephone | 240-284-4641
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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