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General NPI Number Information
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NPI Number | 1275895005
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Entity Type | Organization
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Legal Business Name | THE SALVATION ARMY
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Dates
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Enumeration Date | 06/07/2012
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Last Update Date | 06/07/2012
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Provider Practice Location Address
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Address Line | 155004 CORSAIR AVENUE
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City | TIYAN
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State | GU
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Zip | 96910-5004
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Country | US
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Telephone | 671-477-7671
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Fax | 671-477-4649
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Provider Business Mailing Address
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Address Line | PO BOX 23038
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City | BARRIGADA
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State | GU
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Zip | 96921-3038
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Country | US
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Telephone | 671-477-7671
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Fax | 671-477-4649
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Authorized Official
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Title or Position | PROGRAM COORDINATOR
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Name | MS. LOURDES B HONGYEE
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Credential |
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Telephone | 671-477-9801
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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 |
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License Number State | GU
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