Provider Demographics
NPI:1154702587
Name:KINGDOM CAREGIVERS LLC
Entity type:Organization
Organization Name:KINGDOM CAREGIVERS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:RN/EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELISE
Authorized Official - Middle Name:M
Authorized Official - Last Name:FRANCIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-551-4647
Mailing Address - Street 1:PO BOX 7872
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23231-0372
Mailing Address - Country:US
Mailing Address - Phone:804-551-4647
Mailing Address - Fax:804-482-2842
Practice Address - Street 1:2210 CARTER ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23222-2407
Practice Address - Country:US
Practice Address - Phone:804-321-1016
Practice Address - Fax:804-321-1017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-11
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAADC14-1103720261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0158520384Medicaid