Healthcare Provider Details

I. General information

NPI: 1992366645
Provider Name (Legal Business Name): ONE TOUCH OF CHRIST EVANGELISTIC MINISTRIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2019
Last Update Date: 02/16/2023
Certification Date: 02/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5701 SHINGLE CREEK PKWY STE 650
BROOKLYN CENTER MN
55430-2492
US

IV. Provider business mailing address

5701 SHINGLE CREEK PKWY STE 650
BROOKLYN CENTER MN
55430-2492
US

V. Phone/Fax

Practice location:
  • Phone: 763-762-6708
  • Fax: 763-762-6537
Mailing address:
  • Phone: 763-762-6708
  • Fax: 763-762-6537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MISS CHRISTIANA O GREENE
Title or Position: CHAIRMAN/PROGRAM ADMINISTRATOR
Credential:
Phone: 612-328-4819