Healthcare Provider Details

I. General information

NPI: 1245929991
Provider Name (Legal Business Name): HUMBLE BEGINNINGS CHRISTIAN MINISTRIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2023
Last Update Date: 05/08/2023
Certification Date: 05/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6035 WERTZVILLE RD
ENOLA PA
17025
US

IV. Provider business mailing address

6035 WERTZVILLE RD
ENOLA PA
17025
US

V. Phone/Fax

Practice location:
  • Phone: 717-438-4878
  • Fax:
Mailing address:
  • Phone: 717-438-4878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN D. GODDARD
Title or Position: CEO/FOUNDER
Credential: ED.D
Phone: 717-438-4878