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General NPI Number Information
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NPI Number | 1992290332
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Entity Type | Organization
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Legal Business Name | THE KINGDOM FOUNDATION
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Dates
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Enumeration Date | 06/27/2018
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Last Update Date | 06/27/2018
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Provider Practice Location Address
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Address Line | 110 EXCHANGE ST STE C
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City | DANVILLE
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State | VA
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Zip | 24541-3500
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Country | US
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Telephone | 434-421-9447
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Fax | 434-857-2219
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Provider Business Mailing Address
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Address Line | 110 EXCHANGE ST STE C
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City | DANVILLE
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State | VA
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Zip | 24541-3500
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Country | US
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Telephone | 434-421-9447
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Fax | 434-857-2219
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Authorized Official
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Title or Position | CEO/PRESIDENT
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Name | MR. CECIL EZEKIEL BRIDGEFORTH
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Credential |
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Telephone | 434-421-9447
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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