Kingdom Care Senior Living, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

KINGDOM CARE SENIOR LIVING, LLC

Practice address

811 Center St
Fulton, MO 65251-1922

Phone

(573) 416-2531

NPI assigned

Aug 20, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Bobbie Denise Young, RN, BSN

Title

Consultant

Phone

(573) 683-1355

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Skilled nursing facility certification: CCN 265581

Legal name

KINGDOM CARE SENIOR LIVING, LLC

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Jul 1, 1994

Last certification

Sep 12, 2024

Beds

36

Ownership / control type

Limited Liability Corporation

Multi-facility organization

LEGENDARY LAND HOLDINGS LLC

Most recent change of ownership

Sep 15, 2020

Organization structure

LLCProprietary

Enrollment address

811 Center Street
Fulton, MO 65251-1922

Nursing home name

KINGDOM CARE SENIOR LIVING

Listed as

Kingdom Care Senior LivingCCN 265581 · All quality measures

Overall star rating

4 of 5

Health inspections

3 of 5

Staffing

4 of 5

Quality measures

5 of 5

Type

Medicare and Medicaid

Ownership

For profit - Limited Liability company

Certified

Jul 1, 1994

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

3627.4 residents per day on average

Processed by Care Compare on Aug 1, 2026.

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

All disclosed owners & managing parties 5

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Beth Ann Sjoblom, MD

  • Internal Medicine Physician
  • Columbia, MO
  • NPI 1558371781

  Adp of the SNF

  CMS ownership

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Beth Ann Sjoblom, MD

  • Internal Medicine Physician
  • Columbia, MO
  • NPI 1558371781
  NPD (past)

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Beth Ann Sjoblom, MD

  • Internal Medicine Physician
  • Columbia, MO
  • NPI 1558371781

  Nursing home

  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1597881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687132800000",
    "number": "1336751338",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 456",
            "city": "PARMA",
            "state": "MO",
            "postal_code": "638700456",
            "telephone_number": "573-683-1355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "811 CENTER ST",
            "city": "FULTON",
            "state": "MO",
            "postal_code": "652511922",
            "telephone_number": "573-416-2531"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KINGDOM CARE SENIOR LIVING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-20",
        "last_updated": "2023-06-19",
        "certification_date": "2023-06-19",
        "status": "A",
        "authorized_official_last_name": "YOUNG",
        "authorized_official_first_name": "BOBBIE",
        "authorized_official_middle_name": "DENISE",
        "authorized_official_title_or_position": "CONSULTANT",
        "authorized_official_telephone_number": "573-683-1355",
        "authorized_official_credential": "RN, BSN"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jwtdo, LLC (Just What the Doctor Ordered)
• John L Keener, RPH
• Kingdom Care Alf LLC
• Kingdom Care Assisted Living, LLC
• Kingdom Care Opco LLC
• Jeffrey S. Kline, PH.D.
• Morgan Kluge, MD
• Katelyn Nicole Koebel, PHARMD
• Koelling Family Chiropractic, PC
• Bryce D Koelling, D.C.

• Skilled Nursing Facility in Fulton, MO
• Providers in Fulton, MO by specialty
• Skilled Nursing Facility in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.