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General NPI Number Information
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NPI Number | 1255739314
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Entity Type | Organization
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Legal Business Name | BODY OF CHRIST ASSEMBLY
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Dates
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Enumeration Date | 12/05/2014
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Last Update Date | 12/05/2014
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Provider Practice Location Address
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Address Line | 1614 SUMMERS DR
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City | CEDAR HILL
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State | TX
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Zip | 75104-4920
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Country | US
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Telephone | 469-261-0532
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Fax | 972-299-9369
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Provider Business Mailing Address
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Address Line | 1614 SUMMER DR.
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City | CEDAR HILL
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State | TX
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Zip | 75104
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Country | US
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Telephone | 469-261-0532
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Fax | 972-299-9369
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Authorized Official
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Title or Position | PASTOR/CEO
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Name | MR. FREDRICK LYNN EDDINGTON SR.
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Credential |
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Telephone | 469-261-0532
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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