Provider Demographics
NPI:1821661414
Name:KINGDOM HOME CARE LLC
Entity Type:Organization
Organization Name:KINGDOM HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SYCTRILOS
Authorized Official - Middle Name:YVETTE
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-286-2144
Mailing Address - Street 1:3150 GARDNER OAKS LN
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33810-3551
Mailing Address - Country:US
Mailing Address - Phone:863-286-2144
Mailing Address - Fax:
Practice Address - Street 1:3150 GARDNER OAKS LN
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33810-3551
Practice Address - Country:US
Practice Address - Phone:863-286-2144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-21
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
No251E00000XAgenciesHome Health