Kingdom Village Group Home

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

Legal business name

KINGDOM VILLAGE GROUP HOME

Practice address

3021 Greatbear Way
Kissimmee, FL 34746-2116

Phone

(330) 329-1588

Fax

(407) 201-5348

NPI assigned

Jan 31, 2022

Organization subpart

No

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

Authorized official

Name

Mrs. Latosha Riley

Title

Ceo

Phone

(330) 329-1588

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1643587200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643587200000",
    "number": "1700539756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3021 GREATBEAR WAY",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347462116",
            "telephone_number": "330-329-1588",
            "fax_number": "407-201-5348"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3021 GREATBEAR WAY",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347462116",
            "telephone_number": "330-329-1588",
            "fax_number": "407-201-5348"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KINGDOM VILLAGE GROUP HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-31",
        "last_updated": "2022-01-31",
        "certification_date": "2022-01-31",
        "status": "A",
        "authorized_official_last_name": "RILEY",
        "authorized_official_first_name": "LATOSHA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "330-329-1588",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010293900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gerald Lee King-Morales
• Angelika King, COTA/L
• Tiana S King, DNP, FNP-BC PMHNP-BC
• Kingdom Behavior Principles
• Kingdom Come Enterprises Inc
• Kinsey Chiropractic, P.a.
• James Kinsey, D.C.
• Melody Lane Kipp, PHD
• Alyssa Kirby
• Patricia Evadne Kirschner, P.T.A.

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Kissimmee, FL
• Providers in Kissimmee, FL by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.