# KINGDOM CARE AGENCY LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1124812987
- **Authorized official:** TAYANNA LEWIS (OWNER/ FOUNDER)
- **Authorized official phone:** (339) 208-2001

## Contact information

- **Practice address:** 2 GRANITE AVE STE 260, MILTON, MA 02186
- **Practice address phone:** (339) 987-6499
- **Mailing address:** 68 HARRISON AVE STE 605, BOSTON, MA 02111-1929

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103TM1800X | Intellectual & Developmental Disabilities Psychologist | — | NULL | — |
| 251J00000X | Nursing Care Agency | — | NULL | — |
| 253Z00000X | In Home Supportive Care Agency | — | NULL | Yes |
| 283XC2000X | Children's Rehabilitation Hospital | — | NULL | — |
| 385H00000X | Respite Care | — | NULL | — |

## Other

- **Enumeration date:** 04/07/2025
- **Last updated:** 04/07/2025