Provider Demographics
NPI:1407367998
Name:KINGDOM CARE TRANSPORTATION LLC
Entity Type:Organization
Organization Name:KINGDOM CARE TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACI
Authorized Official - Middle Name:NIKOL
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-501-9456
Mailing Address - Street 1:3621 MILLERS GLEN LN APT 106
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23231-2365
Mailing Address - Country:US
Mailing Address - Phone:804-501-9456
Mailing Address - Fax:
Practice Address - Street 1:3621 MILLERS GLEN LN APT 106
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23231-2365
Practice Address - Country:US
Practice Address - Phone:804-501-9456
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-24
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)