Provider Demographics
NPI:1669191417
Name:KINGDOM HOMES
Entity type:Organization
Organization Name:KINGDOM HOMES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELISANGELA
Authorized Official - Middle Name:MENDES
Authorized Official - Last Name:CUNHA-AFONSO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:508-840-2678
Mailing Address - Street 1:69 FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-2903
Mailing Address - Country:US
Mailing Address - Phone:508-840-2678
Mailing Address - Fax:
Practice Address - Street 1:1256 PARK ST
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-3745
Practice Address - Country:US
Practice Address - Phone:508-840-2678
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency