KINGDOM HEALTHCARE SERVICES (NPI# 1750913349) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1750913349 |
| Entity Type | Organization |
| Organization Name | KINGDOM HEALTHCARE SERVICES |
| Practice Address |
215 Palisades Dr Dallas GA 30157-0928 |
| Practice Telephone | 6789784947 |
| Mailing Telephone | 6789784947 |
| Enumeration Date | 2020-02-11 |
| Last Update Date | 2020-02-11 |
| Authorized Official Name | LUCILLE M TRAVIS (CEO) |
| Authorized Official Telephone | 6789784947 |
| Authorized Official Credential | NP |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 310400000X | Assisted Living Facility | Nursing & Custodial Care Facilities | ||
| N | 251E00000X | Home Health | Agencies | ||
| N | 3104A0630X |
Assisted Living Facility Specialization: Assisted Living, Behavioral Disturbances |
Nursing & Custodial Care Facilities | ||
| N | 314000000X | Skilled Nursing Facility | Nursing & Custodial Care Facilities | ||
| Y | 3104A0625X |
Assisted Living Facility Specialization: Assisted Living, Mental Illness |
Nursing & Custodial Care Facilities |
| Street Address |
215 PALISADES DR |
| City | DALLAS |
| State | GA |
| Zip Code | 30157-0928 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093206674 | Lucille Travis | Nurse Practitioner | 215 Palisades Dr, Dallas, GA 30157-0928 | 2018-05-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922608629 | Harshadbhai Vinubhai Patel | Pharmacist | 3615 Marietta Highway, Dallas, GA 30157 | 2020-10-30 |
| 1043852627 | Lindsay Sheets | Dentist | 59 Hillside Trce Ste 105, Dallas, GA 30157 | 2019-10-15 |
| 1619459062 | Emily Nicole Koopman | Specialist/Technologist | 399 Powder Creek Way, Dallas, GA 30157 | 2018-09-02 |
| 1073969861 | Rachel Spencer | Physical Therapist | 99 Hillside Trace, Dallas, GA 30157 | 2016-05-11 |
| 1336514827 | Petal Shields | Community Health Worker | 121 Omega Ct, Dallas, GA 30157 | 2015-12-09 |
| 1851797294 | Annette Moncion | Nurse Practitioner | 32 Midland Lane, Dallas, GA 30157 | 2014-11-12 |
| 1003211079 | Melissa Brice | Lactation Consultant, Non-RN | 430 Parson Rd, Dallas, GA 30157 | 2014-11-03 |
| 1104101690 | Jared Alan Lott | Pharmacist | 303 Charlie Watts Blvd, Dallas, GA 30157 | 2011-10-15 |
| 1972888758 | Lisa Nicole Mcentire | Massage Therapist | 119 Fairview Oak Trace, Dallas, GA 30157 | 2011-10-12 |
| 1548570120 | Chad Stough | Physician Assistant | 2713 Marietta Highway, Suite 122, Dallas, GA 30157 | 2010-10-15 |
| Find all providers in zip 30157 | ||||
| Taxonomy Code | 3104A0625X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Assisted Living Facility |
| Specialization | Assisted Living, Mental Illness |
| A facility providing supportive services to individuals who can function independently in most areas of activity, but need special guidance, assistance and/or monitoring as the result of a psychiatric problem. This type of facility requires a staff with special training in mental health training and dealing with psychiatric emergencies. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073934162 | Easter Seals Ucp North Carolina & Virginia Inc. | Assisted Living Facility | 1015 Elizabeth Dr, Dallas, NC 28034-7751 | 2013-12-17 |
| 1508137548 | House of Victory | Assisted Living Facility | 2819 Ainwick Ct, Dallas, TX 75227-6720 | 2012-01-23 |
| 1134498561 | Spears House of Care | Assisted Living Facility | 734 Seabeach Rd, Dallas, TX 75232-4845 | 2011-12-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083215842 | Stewart Community Home, Inc. | Assisted Living Facility | 1125 15th St, Columbus, GA 31901-2219 | 2020-11-06 |
| 1952851602 | Gates Health Care Services, LLC | Assisted Living Facility | 400 Wallace Cir, Bloomingdale, GA 31302-8050 | 2016-10-06 |
| 1801251202 | Prime Veritas | Assisted Living Facility | 1889 Trinity Mill Dr, Dacula, GA 30019-1015 | 2015-12-30 |
| 1053730267 | Hooks Home of Care | Assisted Living Facility | 4466 Pinedale Dr, Macon, GA 31206-4530 | 2014-04-15 |
| 1699024141 | Transitional Hope Unlimited | Assisted Living Facility | 4 Harvey St Ne, Rome, GA 30161-5122 | 2012-08-30 |
| 1164782223 | Sweet Pea Personal Care Home | Assisted Living Facility | 9387 Burkhalter Rd, Statesboro, GA 30461-6765 | 2012-05-23 |
| 1447532007 | Pendley Personal Care Home Inc. | Assisted Living Facility | 2548 Central Ave, Augusta, GA 30904-6240 | 2011-09-09 |
| 1215216445 | Paula's Safe House | Assisted Living Facility | 3900 Rockey Valley Dr, Conley, GA 30288-1410 | 2011-08-04 |
| 1174819619 | Prn Nursing and Alternative Living Family Care Solutions | Assisted Living Facility | 115 Lakeshore Dr S, Ivey, GA 31031-3537 | 2011-06-23 |
| 1477859841 | Fairview Community Personal Care Home, Inc. | Assisted Living Facility | 2470 Fairview Rd Se, Conyers, GA 30013-4919 | 2011-02-02 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.