Provider Demographics
NPI:1902693815
Name:KINGDOM ON EARTH SUPPORTIVE LIVING LLC
Entity type:Organization
Organization Name:KINGDOM ON EARTH SUPPORTIVE LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:LOVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-709-8244
Mailing Address - Street 1:13321 AUGUST DR
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36695-8595
Mailing Address - Country:US
Mailing Address - Phone:251-709-8244
Mailing Address - Fax:251-865-1669
Practice Address - Street 1:13321 AUGUST DR
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36695-8595
Practice Address - Country:US
Practice Address - Phone:251-709-8244
Practice Address - Fax:251-865-1669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-23
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No174200000XOther Service ProvidersMeals
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)