Healthcare Provider Details

I. General information

NPI: 1316632268
Provider Name (Legal Business Name): THE WORSHIP CENTRE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2023
Last Update Date: 10/24/2023
Certification Date: 10/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2830 E MANNING AVE
FOWLER CA
93625-9510
US

IV. Provider business mailing address

2830 E MANNING AVE
FOWLER CA
93625-9510
US

V. Phone/Fax

Practice location:
  • Phone: 559-834-1730
  • Fax:
Mailing address:
  • Phone: 559-834-1730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State

VIII. Authorized Official

Name: MARK GRICE
Title or Position: DIRECTOR OF CALAIM
Credential:
Phone: 559-351-3365