Healthcare Provider Details

I. General information

NPI: 1598023327
Provider Name (Legal Business Name): KINGDOM COMMUNITY MINISTRIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2012
Last Update Date: 02/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5330 OFFICE CENTER CT SUITE #27
BAKERSFIELD CA
93309-1562
US

IV. Provider business mailing address

5330 OFFICE CENTER CT SUITE #27
BAKERSFIELD CA
93309-1562
US

V. Phone/Fax

Practice location:
  • Phone: 661-324-4070
  • Fax:
Mailing address:
  • Phone: 661-324-4070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL JOSEPH MANNIA
Title or Position: PRESIDENT
Credential: D.MIN.
Phone: 661-324-4070