Provider Demographics
NPI:1962235275
Name:KINGDOMS ROAD, LLC
Entity type:Organization
Organization Name:KINGDOMS ROAD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TYSON
Authorized Official - Middle Name:TERRELL
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-632-0560
Mailing Address - Street 1:3626 N HALL ST STE 610
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-5131
Mailing Address - Country:US
Mailing Address - Phone:469-232-7969
Mailing Address - Fax:469-402-7562
Practice Address - Street 1:3626 N HALL ST STE 610
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-5131
Practice Address - Country:US
Practice Address - Phone:469-232-7969
Practice Address - Fax:469-402-7562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)