MEDICARE: NEW KINGDOM LIVING FOUNDATION CARE

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	376J00000X	Homemaker
2	385H00000X	Respite Care
3	251E00000X	Home Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902604457
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW KINGDOM LIVING FOUNDATION CARE

Provider Business Mailing Address
First Line	:	1819 BRENTWOOD CT
Second Line	:
City	:	DAVENPORT
State	:	FL
Zip	:	33837-1795
Country	:	US
Telephone Number	:	267-774-1625
Fax Number	:

Provider Business Practice Location Address
First Line	:	1800 POST OAK DR
Second Line	:
City	:	DAVENPORT
State	:	FL
Zip	:	33837-8515
Country	:	US
Telephone Number	:	267-774-1625
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JASMINE WARDLAW
Credential	:
Telephone Number	:	321-443-6351

Provider Enumeration Date	:	03/03/2025
Last Update Date	:	12/18/2025

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