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Organization

KINGDOM CARE, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MS. DETRA RENILLA MCCARTY (OWNER, DIRECTOR)
(601) 274-2233
Entity
Organization

Contact information

Practice address
349 COUNTY ROAD 273, SHUBUTA, MS 39360-8918
(601) 274-2831
Mailing address
349 COUNTY ROAD 273, SHUBUTA, MS 39360-8918
(601) 274-2831

Taxonomy

Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
385H00000X
Respite Care
Primary
385HR2065X
Child Physical Disabilities Respite Care

Other

Enumeration date
06/27/2022
Last updated
06/27/2022
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