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General NPI Number Information
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NPI Number | 1538469143
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Entity Type | Organization
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Legal Business Name | HOUSE OF PRAYER
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Dates
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Enumeration Date | 10/28/2010
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Last Update Date | 10/28/2010
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Provider Practice Location Address
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Address Line | 919 E 30TH ST
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City | TUCSON
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State | AZ
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Zip | 85713-3605
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Country | US
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Telephone | 520-792-3462
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Fax | 520-624-7955
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Provider Business Mailing Address
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Address Line | 925 E 30TH ST
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City | TUCSON
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State | AZ
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Zip | 85713-3605
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Country | US
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Telephone | 520-792-3462
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Fax | 520-624-7955
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARTHA M. MUNGUIA
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Credential |
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Telephone | 520-792-3462
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | AL6429H
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License Number State | AZ
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