Provider Demographics
NPI:1790346633
Name:KINGDOM 1ST HEALTH AMD HUMAN SERVICES
Entity Type:Organization
Organization Name:KINGDOM 1ST HEALTH AMD HUMAN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:LLORRAINE
Authorized Official - Last Name:TEMPLE
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:623-216-9620
Mailing Address - Street 1:8733 W SHERIDAN ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-3658
Mailing Address - Country:US
Mailing Address - Phone:623-216-9620
Mailing Address - Fax:
Practice Address - Street 1:8733 W SHERIDAN ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-3658
Practice Address - Country:US
Practice Address - Phone:623-216-9620
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-21
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health