Healthcare Provider Details

I. General information

NPI: 1699104968
Provider Name (Legal Business Name): SABAOTH GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2013
Last Update Date: 11/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

774 ROCKAWAY AVE
BROOKLYN NY
11212-5807
US

IV. Provider business mailing address

475 RIVERDALE AVE
BROOKLYN NY
11207-6130
US

V. Phone/Fax

Practice location:
  • Phone: 718-676-4020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name: VARISE COOPER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 718-676-4020