Provider Demographics
NPI:1952629164
Name:KINGDOM CARE SERVICES, LLC
Entity Type:Organization
Organization Name:KINGDOM CARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TEQUITA
Authorized Official - Middle Name:C
Authorized Official - Last Name:OBIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-270-5124
Mailing Address - Street 1:1710 WESTBROOK AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-8721
Mailing Address - Country:US
Mailing Address - Phone:336-270-5124
Mailing Address - Fax:336-270-5125
Practice Address - Street 1:1710 WESTBROOK AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-8721
Practice Address - Country:US
Practice Address - Phone:336-270-5124
Practice Address - Fax:336-270-5125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-12
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-001-193251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health