Provider Demographics
NPI:1215757190
Name:KINGDOM FAMILY NW
Entity type:Organization
Organization Name:KINGDOM FAMILY NW
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHOCHO
Authorized Official - Middle Name:
Authorized Official - Last Name:FAIFAI
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:360-216-9846
Mailing Address - Street 1:821 NW 175TH WAY
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:WA
Mailing Address - Zip Code:98642-6963
Mailing Address - Country:US
Mailing Address - Phone:360-216-9846
Mailing Address - Fax:
Practice Address - Street 1:10804 NE HIGHWAY 99
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-5655
Practice Address - Country:US
Practice Address - Phone:360-342-8622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-15
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management