Healthcare Provider Details

I. General information

NPI: 1700148954
Provider Name (Legal Business Name): WORD OF LIFE MINISTRY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2012
Last Update Date: 06/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1303 W 88TH ST
LOS ANGELES CA
90044-2127
US

IV. Provider business mailing address

PO BOX 2631
FRESNO CA
93745-2631
US

V. Phone/Fax

Practice location:
  • Phone: 559-579-0649
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number242415
License Number StateCA

VIII. Authorized Official

Name: CALVIN W BYNUM
Title or Position: PRESIDENT
Credential:
Phone: 559-579-0649