=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871283549
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KINGDOM HOSPICE & PALLIATIVE CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/08/2023
-----------------------------------------------------
Last Update Date | 11/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13100 W BELLFORT AVE # APPT318
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77099-4828
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-245-3896
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12409 NECTAR CT
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77082-5645
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-407-0596
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | OBIDIGBO EMEGOAKOR
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 832-245-3896
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------