Provider Demographics
NPI:1053297739
Name:KINGDOM SONS LEGACY HOUSE CORP
Entity type:Organization
Organization Name:KINGDOM SONS LEGACY HOUSE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:KRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:RODGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-668-8169
Mailing Address - Street 1:8531 ZANE LN
Mailing Address - Street 2:
Mailing Address - City:PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34668-1261
Mailing Address - Country:US
Mailing Address - Phone:706-668-8169
Mailing Address - Fax:
Practice Address - Street 1:8531 ZANE LN
Practice Address - Street 2:
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-1261
Practice Address - Country:US
Practice Address - Phone:706-668-8169
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JACK C. MONTGOMERY VA MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-08-15
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care