Provider Demographics
NPI:1255693586
Name:KINGDOM LIVING
Entity Type:Organization
Organization Name:KINGDOM LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:AZZINARO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-681-0806
Mailing Address - Street 1:119 WINDSOR DR
Mailing Address - Street 2:
Mailing Address - City:SWEDESBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08085-2519
Mailing Address - Country:US
Mailing Address - Phone:215-681-0806
Mailing Address - Fax:
Practice Address - Street 1:119 WINDSOR DR
Practice Address - Street 2:
Practice Address - City:SWEDESBORO
Practice Address - State:NJ
Practice Address - Zip Code:08085-2519
Practice Address - Country:US
Practice Address - Phone:215-681-0806
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children