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General NPI Number Information
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NPI Number | 1174815583
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Entity Type | Organization
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Legal Business Name | LAMB OF GOD MINISTRIES INCORPORATED
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Dates
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Enumeration Date | 05/04/2011
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Last Update Date | 05/04/2011
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Provider Practice Location Address
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Address Line | 1012 S PARROTT AVE
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City | OKEECHOBEE
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State | FL
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Zip | 34974-5268
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Country | US
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Telephone | 863-467-2677
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Fax | 863-467-0677
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Provider Business Mailing Address
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Address Line | 1012 S PARROTT AVE
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City | OKEECHOBEE
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State | FL
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Zip | 34974-5268
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Country | US
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Telephone | 863-467-2677
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Fax | 863-467-0677
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. LYLE R FRIED
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Credential | C.A.P.
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Telephone | 863-467-2677
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 1947AD975000
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License Number State | FL
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