Provider Demographics
NPI:1285479931
Name:KINGDOM 1ST HOME CARE AGENCY
Entity type:Organization
Organization Name:KINGDOM 1ST HOME CARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PATRICE
Authorized Official - Middle Name:
Authorized Official - Last Name:FINLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-731-0707
Mailing Address - Street 1:5150 N 99TH AVE
Mailing Address - Street 2:APT 2101
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85305-3022
Mailing Address - Country:US
Mailing Address - Phone:612-731-0707
Mailing Address - Fax:
Practice Address - Street 1:5150 N 99TH AVE
Practice Address - Street 2:APT 2101
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85305-3022
Practice Address - Country:US
Practice Address - Phone:612-731-0707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No174200000XOther Service ProvidersMeals
No251G00000XAgenciesHospice Care, Community Based
No253Z00000XAgenciesIn Home Supportive Care