MEDICARE: CARE KINGDOM HEALTH SYSTEM LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1457166605
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARE KINGDOM HEALTH SYSTEM LLC

Provider Business Mailing Address
First Line	:	732 S 6TH ST STE V
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89101-6948
Country	:	US
Telephone Number	:	503-388-1611
Fax Number	:

Provider Business Practice Location Address
First Line	:	732 S 6TH ST STE V
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89101-6948
Country	:	US
Telephone Number	:	503-388-1611
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TYESHA DEAN
Credential	:
Telephone Number	:	503-388-1611

Provider Enumeration Date	:	02/12/2025
Last Update Date	:	03/03/2026

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