Provider Demographics
NPI:1467220715
Name:KINGDOM LEGACY CARE LLC
Entity Type:Organization
Organization Name:KINGDOM LEGACY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:FRANCESCA
Authorized Official - Last Name:MONDELUS
Authorized Official - Suffix:
Authorized Official - Credentials:RN BSN
Authorized Official - Phone:754-235-0044
Mailing Address - Street 1:6001 NW 89TH AVE
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-4105
Mailing Address - Country:US
Mailing Address - Phone:754-235-0044
Mailing Address - Fax:
Practice Address - Street 1:6001 NW 89TH AVE
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-4105
Practice Address - Country:US
Practice Address - Phone:754-235-0044
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-15
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care