Healthcare Provider Details

I. General information

NPI: 1275813743
Provider Name (Legal Business Name): MUSTARD SEED FAITH CATHEDRAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2011
Last Update Date: 08/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

633 PINSON VALLEY PKWY
BIRMINGHAM AL
35217-2923
US

IV. Provider business mailing address

633 PINSON VALLEY PKWY
BIRMINGHAM AL
35217-2923
US

V. Phone/Fax

Practice location:
  • Phone: 205-849-9194
  • Fax: 205-849-8112
Mailing address:
  • Phone: 205-849-9194
  • Fax: 205-849-8112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANNETTE W. DUNNER
Title or Position: PROGRAM DIRECTOR
Credential: B.A.
Phone: 205-849-8194