Provider Demographics
NPI:1790103174
Name:KYNGDOM SERVICES LLC
Entity Type:Organization
Organization Name:KYNGDOM SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-674-8988
Mailing Address - Street 1:750 S ORANGE BLOSSOM TRL
Mailing Address - Street 2:227
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32805-3118
Mailing Address - Country:US
Mailing Address - Phone:407-674-8988
Mailing Address - Fax:407-674-8992
Practice Address - Street 1:750 S ORANGE BLOSSOM TRL
Practice Address - Street 2:227
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32805-3118
Practice Address - Country:US
Practice Address - Phone:407-674-8988
Practice Address - Fax:407-674-8992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-02
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003575300Medicaid