NPIMap

Organization Active NPI

Kingdom Behavioral Health LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Hagerstown, MD
National Provider Identifier
1750904314
Registry record updated Jun 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
KINGDOM BEHAVIORAL HEALTH LLC
Practice address
5 Public SQ Ste 213
Hagerstown, MD 21740-5599
Phone
(240) 284-4641
Fax
(240) 284-4671
NPI assigned
May 18, 2020
Last updated
Jun 3, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2020

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

Authorized official

Name
Mr. Taofeek Bello, NURSE PRACTITIONER
Title
Presisent/ Ceo
Phone
(240) 284-4641

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LP0808X Primary

Addresses

Primary practice location

5 Public SQ Ste 213
Hagerstown, MD 21740-5599

Mailing address

5 Public SQ Ste 213
Hagerstown, MD 21740-5599
Phone (240) 284-4641

Other identifiers 1

IdentifierTypeStateIssuer
007559100MedicaidMD

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL crowdstrike Direct

National Provider Directory

National Provider Directory

Locations

5 Public Sq
Ste 213
Hagerstown, MD 21740
Phone (240) 284-4641

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1589760000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1591142400000",
    "number": "1750904314",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 PUBLIC SQ STE 213",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217405599",
            "telephone_number": "240-284-4641",
            "fax_number": "240-284-4671"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 PUBLIC SQ STE 213",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217405599",
            "telephone_number": "240-284-4641",
            "fax_number": "240-284-4671"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KINGDOM BEHAVIORAL HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-18",
        "last_updated": "2020-06-03",
        "certification_date": "2020-06-03",
        "status": "A",
        "authorized_official_last_name": "BELLO",
        "authorized_official_first_name": "TAOFEEK",
        "authorized_official_title_or_position": "PRESISENT/ CEO",
        "authorized_official_telephone_number": "240-284-4641",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "NURSE PRACTITIONER"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "007559100",
            "state": "MD"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "crowdstrike",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "5 Public Sq Ste 213",
            "city": "Hagerstown",
            "state": "MD",
            "country_code": "US",
            "postal_code": "217405599",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Hagerstown, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2020; 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.