Provider Demographics
NPI:1225781768
Name:KINGDOM 1ST HOME CARE LLC
Entity Type:Organization
Organization Name:KINGDOM 1ST HOME CARE LLC
Other - Org Name:KINGDOM 1ST HOME CARE LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:URSULA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-745-9124
Mailing Address - Street 1:304A MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BAYBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28515-9528
Mailing Address - Country:US
Mailing Address - Phone:252-745-9124
Mailing Address - Fax:252-745-9256
Practice Address - Street 1:304A MAIN ST
Practice Address - Street 2:
Practice Address - City:BAYBORO
Practice Address - State:NC
Practice Address - Zip Code:28515-9528
Practice Address - Country:US
Practice Address - Phone:252-745-9124
Practice Address - Fax:252-745-9256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-03
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care