Provider Demographics
NPI:1467170134
Name:KINGDOM C.A.R.E PERSONAL SERVICES
Entity Type:Organization
Organization Name:KINGDOM C.A.R.E PERSONAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VERA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-659-0036
Mailing Address - Street 1:101 S DICKSON ST
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360-5203
Mailing Address - Country:US
Mailing Address - Phone:314-659-0036
Mailing Address - Fax:
Practice Address - Street 1:101 S DICKSON ST
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-5203
Practice Address - Country:US
Practice Address - Phone:314-659-0036
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KINGDOM COVENANT CONNECTIONS FELLOWSHIP INTERNATIONAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-08-18
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care