1154702587 NPI number — KINGDOM CAREGIVERS LLC

Table of content: (NPI 1154702587)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154702587 NPI number — KINGDOM CAREGIVERS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KINGDOM CAREGIVERS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SENIORS 1ST CHOICE ADULT DAY CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154702587
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/11/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7872
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HENRICO
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23231-0372
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-551-4647
Provider Business Mailing Address Fax Number:
804-482-2842

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2210 CARTER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23222-2407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-321-1016
Provider Business Practice Location Address Fax Number:
804-321-1017
Provider Enumeration Date:
06/11/2015

Additional Information

Authorized Official

Authorized Official Last Name:
FRANCIS
Authorized Official First Name:
ANGELISE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
RN/EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
804-551-4647

Provider Taxonomy Codes

  • Taxonomy code: 261QA0600X , with the licence number:  ADC14-1103720 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0158520384 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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