Provider Demographics
NPI:1023627510
Name:KINGDOM BEHAVIORAL HEALTH LLC
Entity type:Organization
Organization Name:KINGDOM BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TAOFEEK
Authorized Official - Middle Name:ADEKUNLE
Authorized Official - Last Name:BELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-968-1153
Mailing Address - Street 1:5 PUBLIC SQ STE 213
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-5599
Mailing Address - Country:US
Mailing Address - Phone:443-968-1153
Mailing Address - Fax:
Practice Address - Street 1:5 PUBLIC SQ STE 213
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-5599
Practice Address - Country:US
Practice Address - Phone:443-968-1153
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-30
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty