Provider Demographics
NPI:1063390458
Name:KINGDOM CARE ALTERNATIVE FAMILY LIVING LLC
Entity type:Organization
Organization Name:KINGDOM CARE ALTERNATIVE FAMILY LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KALYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:BLOW
Authorized Official - Suffix:
Authorized Official - Credentials:BS,QP
Authorized Official - Phone:252-814-0908
Mailing Address - Street 1:2224 BELLAMY CIR APT 111
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-7260
Mailing Address - Country:US
Mailing Address - Phone:252-814-0908
Mailing Address - Fax:
Practice Address - Street 1:204 E ARLINGTON BLVD STE C
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5022
Practice Address - Country:US
Practice Address - Phone:252-814-0908
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-25
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251E00000XAgenciesHome Health
No251S00000XAgenciesCommunity/Behavioral Health
No261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility
No385H00000XRespite Care FacilityRespite Care
No385HR2050XRespite Care FacilityRespite CareRespite Care Camp
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child