Healthcare Provider Details

I. General information

NPI: 1578931424
Provider Name (Legal Business Name): 2ND CORINTHIANS OUTREACH MINISTRIES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2015
Last Update Date: 03/10/2021
Certification Date: 03/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3680 SE GATEHOUSE CIR APT 236
STUART FL
34994-5036
US

IV. Provider business mailing address

3680 SE GATEHOUSE CIR APT 236
STUART FL
34994-5036
US

V. Phone/Fax

Practice location:
  • Phone: 772-940-6755
  • Fax:
Mailing address:
  • Phone: 772-940-6755
  • 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 Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: WILLERMINE BROOKINS
Title or Position: PRESIDENT
Credential: MS
Phone: 772-940-6755