Provider Demographics
NPI:1861635294
Name:KINGDOM INVESTORS, LLC
Entity Type:Organization
Organization Name:KINGDOM INVESTORS, LLC
Other - Org Name:KINGDOM MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-746-3233
Mailing Address - Street 1:119 GREENSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:CANONSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15317-1335
Mailing Address - Country:US
Mailing Address - Phone:724-746-3233
Mailing Address - Fax:724-746-3233
Practice Address - Street 1:119 GREENSIDE AVE
Practice Address - Street 2:
Practice Address - City:CANONSBURG
Practice Address - State:PA
Practice Address - Zip Code:15317-1335
Practice Address - Country:US
Practice Address - Phone:724-746-3233
Practice Address - Fax:724-746-3233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-15
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA402380310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility