Healthcare Provider Details

I. General information

NPI: 1245143494
Provider Name (Legal Business Name): VICTORY TEMPLE CHURCH OF ABUNDANT LIFE & FACILITIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1445 N HIGHLAND AVE
JACKSON TN
38301-3405
US

IV. Provider business mailing address

1445 N HIGHLAND AVE
JACKSON TN
38301-3405
US

V. Phone/Fax

Practice location:
  • Phone: 901-497-6070
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: STELLA MINOR
Title or Position: MANAGER
Credential:
Phone: 901-497-6070