10D2209566 CLIA NUMBER - KINGDOM HEALTHCARE SERVICES LLC

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Laboratory Demographics

CLIA Number: 10D2209566

Facility Name: KINGDOM HEALTHCARE SERVICES LLC

Facility Address:
100 NE 15TH ST, STE 205
HOMESTEAD, FL
ZIP 33030
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Facility Phone Number: 314 620-6002

Facility Type: School/Student Health Service

Certificate Type: Waiver

NPI Number: 1013667732

Taxonomy: 261QD1600X - Clinic/Center
An entity, facility, or distinct part of a facility providing comprehensive, multidiscipline diagnostic, treatment, therapy, training, and counseling services to children with congenital disorders that precipitate developmental delays and in many instances mental deficiencies (e.g., Cerebral Palsy, metabolic disorders, Sturge-Weber Syndrome, etc.).

CLIA Record

Field Name	Field Value
CLIA Number	10D2209566
LAB Type	School/Student Health Service
Facility Name	KINGDOM HEALTHCARE SERVICES LLC
Street	100 NE 15TH ST, STE 205
City	HOMESTEAD
State	FL
ZIP	33030
Phone	314 620-6002
CertificateType	4
CertificateEffectiveDate	1/14/2023
CertificateExpirationDate	1/13/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024