Provider Demographics
NPI:1013238740
Name:KINGDOM BUILDING SERVICES LLC
Entity Type:Organization
Organization Name:KINGDOM BUILDING SERVICES LLC
Other - Org Name:KINGDOM BUILDERS MINISTER, INC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GRISSELLE
Authorized Official - Middle Name:IVETTE
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:REV
Authorized Official - Phone:352-678-8554
Mailing Address - Street 1:833 WILLOW RUN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:MINNEOLA
Mailing Address - State:FL
Mailing Address - Zip Code:34715-5768
Mailing Address - Country:US
Mailing Address - Phone:407-347-8204
Mailing Address - Fax:
Practice Address - Street 1:833 WILLOW RUN ST
Practice Address - Street 2:SUITE A
Practice Address - City:MINNEOLA
Practice Address - State:FL
Practice Address - Zip Code:34715
Practice Address - Country:US
Practice Address - Phone:352-678-8554
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KINGDOM BUILDING SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-06-16
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ=========Medicare PIN