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General NPI Number Information
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NPI Number | 1902693815
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Entity Type | Organization
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Legal Business Name | KINGDOM ON EARTH SUPPORTIVE LIVING LLC
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Dates
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Enumeration Date | 04/23/2025
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Last Update Date | 04/23/2025
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Provider Practice Location Address
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Address Line | 13321 AUGUST DR
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City | MOBILE
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State | AL
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Zip | 36695-8595
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Country | US
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Telephone | 251-709-8244
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Fax | 251-865-1669
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Provider Business Mailing Address
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Address Line | 13321 AUGUST DR
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City | MOBILE
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State | AL
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Zip | 36695-8595
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Country | US
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Telephone | 251-709-8244
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Fax | 251-865-1669
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | GEORGE LOVE
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Credential |
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Telephone | 251-709-8244
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174200000X
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Taxonomy Name | Meals Provider
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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