Provider Demographics
NPI:1902330392
Name:KINGDOM WOMEN LLC
Entity Type:Organization
Organization Name:KINGDOM WOMEN LLC
Other - Org Name:PRECIOUS JEWELS HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COOWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MYRRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-377-4224
Mailing Address - Street 1:4941 W DESERT LN
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-7365
Mailing Address - Country:US
Mailing Address - Phone:816-377-4224
Mailing Address - Fax:602-687-9274
Practice Address - Street 1:8311 W FOREST GROVE AVE
Practice Address - Street 2:
Practice Address - City:TOLLESON
Practice Address - State:AZ
Practice Address - Zip Code:85353-3628
Practice Address - Country:US
Practice Address - Phone:816-377-4224
Practice Address - Fax:602-687-9274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-12
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL10150H310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ225857OtherAHCCCS MANAGE CARE NUMBER