Provider Demographics
NPI:1821806761
Name:KINGS QUEENS & CELEBRITIES, SPC
Entity type:Organization
Organization Name:KINGS QUEENS & CELEBRITIES, SPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPLE / CAO / GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUEITA
Authorized Official - Middle Name:
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:CPC, CM
Authorized Official - Phone:253-536-4580
Mailing Address - Street 1:PO BOX 44836
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98448-0836
Mailing Address - Country:US
Mailing Address - Phone:253-536-4580
Mailing Address - Fax:253-584-2469
Practice Address - Street 1:13718 PACIFIC AVE S
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98444-4746
Practice Address - Country:US
Practice Address - Phone:253-536-4580
Practice Address - Fax:253-584-2469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-24
Last Update Date:2024-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)