Provider Demographics
NPI:1427897578
Name:KINGDOM HOUSE
Entity type:Organization
Organization Name:KINGDOM HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF EMOTIONAL & PHYSICAL WE
Authorized Official - Prefix:MS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:M
Authorized Official - Last Name:CALDERA WIMMER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:314-420-0400
Mailing Address - Street 1:1321 S 11TH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63104-3599
Mailing Address - Country:US
Mailing Address - Phone:314-421-0400
Mailing Address - Fax:
Practice Address - Street 1:1321 S 11TH ST
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104-3599
Practice Address - Country:US
Practice Address - Phone:314-421-0400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health