OrganizationKingdom Behavioral Health LlcNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address5 Public Sq Ste 213, Hagerstown, MD 21740-5599(240) 284-4641PECOS EnrollmentBased on the most recent information from CMS, provider Kingdom Behavioral Health Llc does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 3 days ago.Profile DetailsProvider ID1750904314Provider TypeOrganizationFull NameKingdom Behavioral Health LlcSubpartNoEnumeration Date5/18/2020Last Updated6/3/2020Contact InformationPractice LocationPractice Address5 Public Sq Ste 213, Hagerstown, MD 21740-5599Phone(240) 284-4641Fax(240) 284-4671Mailing LocationMailing Address5 Public Sq Ste 213, Hagerstown, MD 21740-5599Phone(240) 284-4641Fax(240) 284-4671Authorized OfficialNameBello, Taofeek (Presisent/ Ceo)Phone(240) 284-4641Provider TaxonomiesCodeDescriptionLicenseCode363LP0808XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicenseUnlisted IssuerProvider IdentifiersIDDescriptionIssuerID007559100DescriptionMedicaidIssuerUnlistedMaryland