Healthcare Provider Details

I. General information

NPI: 1386420511
Provider Name (Legal Business Name): PROMISE CHILD MINISTRIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2023
Last Update Date: 09/04/2023
Certification Date: 09/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 WALKUP AVE STE A
MONROE NC
28110-3989
US

IV. Provider business mailing address

3705 BENTLEY PL
WAXHAW NC
28173-9006
US

V. Phone/Fax

Practice location:
  • Phone: 980-384-6902
  • Fax:
Mailing address:
  • Phone: 980-384-6900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385HR2055X
TaxonomyChild Mental Illness Respite Care
License Number
License Number State

VIII. Authorized Official

Name: MS. GIA BARNES
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 980-384-6900