Provider Demographics
NPI:1184459323
Name:KINGDOM COMPANION NURSE REGISTRY
Entity type:Organization
Organization Name:KINGDOM COMPANION NURSE REGISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:AWILDA
Authorized Official - Middle Name:
Authorized Official - Last Name:THEODORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-507-1601
Mailing Address - Street 1:1601 BELVEDERE RD STE 300E
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406-1554
Mailing Address - Country:US
Mailing Address - Phone:561-507-1601
Mailing Address - Fax:561-214-6139
Practice Address - Street 1:1601 BELVEDERE RD STE 300E
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-1554
Practice Address - Country:US
Practice Address - Phone:561-507-1601
Practice Address - Fax:561-214-6139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-06
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251F00000XAgenciesHome Infusion