Healthcare Provider Details

I. General information

NPI: 1720238256
Provider Name (Legal Business Name): UNIVERSAL LIFE CHURCH INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2008
Last Update Date: 11/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 QUINDARO BLVD
KANSAS CITY KS
66104-5331
US

IV. Provider business mailing address

PO BOX 172149
KANSAS CITY KS
66117-1149
US

V. Phone/Fax

Practice location:
  • Phone: 913-400-1822
  • Fax: 913-371-0493
Mailing address:
  • Phone: 913-400-1822
  • Fax: 913-371-0493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173C00000X
TaxonomyReflexologist
License NumberCERT.#PS-000289
License Number StateCO

VIII. Authorized Official

Name: MR. LESLIE GOOLEY
Title or Position: REFLEXOLOGIST
Credential: CERTIFIED
Phone: 913-375-2503