Provider Demographics
NPI:1407201791
Name:ALPHA KINGDOM CARE INC
Entity Type:Organization
Organization Name:ALPHA KINGDOM CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JACKLINE
Authorized Official - Middle Name:
Authorized Official - Last Name:NGETHE
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:817-818-0999
Mailing Address - Street 1:10412 BEAR HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-6531
Mailing Address - Country:US
Mailing Address - Phone:817-305-3577
Mailing Address - Fax:
Practice Address - Street 1:3730 E MCKINNEY ST
Practice Address - Street 2:SUITE 135
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76208-4676
Practice Address - Country:US
Practice Address - Phone:817-305-3577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-25
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health