Organization
KINGDOM CARE ASSOCIATES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PATRECE SCOTT (OWNER)
(757) 319-3662
Entity
Organization
Contact information
Practice address
3630 WESTERN BRANCH BLVD, PORTSMOUTH, VA 23707-2534
(757) 319-3662
Mailing address
1517 CARSON CRES E, PORTSMOUTH, VA 23701-3111
(757) 319-3662
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
—
—
Other
Enumeration date
01/13/2021
Last updated
04/13/2021
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