Provider Demographics
NPI:1720821820
Name:KING MINISTRIEZ
Entity type:Organization
Organization Name:KING MINISTRIEZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:FREDDIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-962-9754
Mailing Address - Street 1:3655 SIMPSON STUART RD UNIT 41324
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75241-4346
Mailing Address - Country:US
Mailing Address - Phone:978-962-9754
Mailing Address - Fax:
Practice Address - Street 1:3819 HAPPY CANYON DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75241-5230
Practice Address - Country:US
Practice Address - Phone:978-962-9754
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
No282E00000XHospitalsLong Term Care Hospital