Healthcare Provider Details

I. General information

NPI: 1083509293
Provider Name (Legal Business Name): LAMB OF GOD IN CHRIST MINISTRIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2025
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

537 JACKSON ST
FAIRFIELD CA
94533-6101
US

IV. Provider business mailing address

539 JACKSON ST
FAIRFIELD CA
94533-6101
US

V. Phone/Fax

Practice location:
  • Phone: 415-724-2583
  • Fax:
Mailing address:
  • Phone: 415-724-2583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: RENEE TROTTER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 415-724-2583