Provider Demographics
NPI:1588381602
Name:KINGDOM LIFE CHURCH INC.
Entity type:Organization
Organization Name:KINGDOM LIFE CHURCH INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:VALENTINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-310-9226
Mailing Address - Street 1:380 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19464-5637
Mailing Address - Country:US
Mailing Address - Phone:610-310-9226
Mailing Address - Fax:
Practice Address - Street 1:380 WALNUT ST
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-5637
Practice Address - Country:US
Practice Address - Phone:610-310-9226
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KINGDOM LIFE CHURCH INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-10-20
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health