Provider Demographics
NPI:1174802011
Name:KINGDOM CARE SERVICES OF NC, INC.
Entity type:Organization
Organization Name:KINGDOM CARE SERVICES OF NC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TEQUITA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-542-5370
Mailing Address - Street 1:265 EASTCHESTER DR STE 307
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-7731
Mailing Address - Country:US
Mailing Address - Phone:336-542-5370
Mailing Address - Fax:336-542-5371
Practice Address - Street 1:265 EASTCHESTER DR STE 307
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-7731
Practice Address - Country:US
Practice Address - Phone:336-542-5370
Practice Address - Fax:336-542-5371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-10
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health