Provider Demographics
NPI:1003431214
Name:KINGDOM ADULT CARE LLC
Entity Type:Organization
Organization Name:KINGDOM ADULT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER & EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:ISMAIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-572-7974
Mailing Address - Street 1:1770 S BUCKLEY RD UNIT 6
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80017-5640
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1770 S BUCKLEY RD UNIT 7
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80017-5640
Practice Address - Country:US
Practice Address - Phone:720-572-7974
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-12
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372600000XNursing Service Related ProvidersAdult CompanionGroup - Single Specialty