Healthcare Provider Details

I. General information

NPI: 1952418279
Provider Name (Legal Business Name): EPHESIANS LIFE MINISTRIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 02/08/2011
Certification Date:
Deactivation Date: 08/24/2006
Reactivation Date: 09/11/2006

III. Provider practice location address

1620 ELTON RD SUITE #204
SILVER SPRING MD
20903-1740
US

IV. Provider business mailing address

1620 ELTON RD SUITE #204
SILVER SPRING MD
20903-1740
US

V. Phone/Fax

Practice location:
  • Phone: 301-439-7191
  • Fax: 301-439-1169
Mailing address:
  • Phone: 301-439-7191
  • Fax: 301-439-1169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number02951678
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number02951678
License Number StateMD

VIII. Authorized Official

Name: MS. BRENA GIBSON
Title or Position: EXECUTIVE DIRECTOR
Credential: PHD
Phone: 301-439-7191