Provider Demographics
NPI:1336751338
Name:KINGDOM CARE SENIOR LIVING, LLC
Entity type:Organization
Organization Name:KINGDOM CARE SENIOR LIVING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:BOBBIE
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:573-683-1355
Mailing Address - Street 1:PO BOX 456
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:MO
Mailing Address - Zip Code:63870-0456
Mailing Address - Country:US
Mailing Address - Phone:573-683-1355
Mailing Address - Fax:
Practice Address - Street 1:811 CENTER ST
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:MO
Practice Address - Zip Code:65251-1922
Practice Address - Country:US
Practice Address - Phone:573-416-2531
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-20
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility