Healthcare Provider Details

I. General information

NPI: 1598156002
Provider Name (Legal Business Name): CHRIST THE KING FAITH TEMPLE MINISTRIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2015
Last Update Date: 02/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3176 WEIR AVE
WEIRTON WV
26062-4809
US

IV. Provider business mailing address

73 EAST ST.
NEW CUMBERLAND WV
26047-1503
US

V. Phone/Fax

Practice location:
  • Phone: 304-224-1060
  • Fax:
Mailing address:
  • Phone: 740-275-6077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number1302076
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number269712
License Number StateOH

VIII. Authorized Official

Name: MRS. CHRISTINE WILLIAMS
Title or Position: CEO/FOUNDER
Credential: RN
Phone: 304-374-0734