MEDICARE: KINGDOM FAMILY HEALTHCARE

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	:	1881003846
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KINGDOM FAMILY HEALTHCARE

Provider Business Mailing Address
First Line	:	5110 AZALEA TRACE DR APT 1411
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77066-4344
Country	:	US
Telephone Number	:	336-693-3799
Fax Number	:

Provider Business Practice Location Address
First Line	:	5110 AZALEA TRACE DR APT 1411
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77066-4344
Country	:	US
Telephone Number	:	336-693-3799
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JAMAEL GRAVES
Credential	:
Telephone Number	:	336-693-3799

Provider Enumeration Date	:	08/04/2014
Last Update Date	:	08/04/2014

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Directions to “KINGDOM FAMILY HEALTHCARE ” Practice Location

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