Organization
KINGDOM VILLAGE GROUP HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LATOSHA RILEY (CEO)
(330) 329-1588
Entity
Organization
Contact information
Practice address
3021 GREATBEAR WAY, KISSIMMEE, FL 34746-2116
(330) 329-1588
(407) 201-5348
Mailing address
3021 GREATBEAR WAY, KISSIMMEE, FL 34746-2116
(330) 329-1588
(407) 201-5348
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010293900
—
FL
Enumeration date
01/31/2022
Last updated
01/31/2022
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