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General NPI Number Information
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NPI Number | 1649453283
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Entity Type | Organization
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Legal Business Name | MADISON PARK CHRISTIAN CHURCH
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Dates
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Enumeration Date | 12/05/2007
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Last Update Date | 06/18/2008
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Provider Practice Location Address
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Address Line | 4700 BROADWAY ST
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City | QUINCY
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State | IL
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Zip | 62305-9112
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Country | US
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Telephone | 217-222-2529
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Fax | 217-222-2895
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Provider Business Mailing Address
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Address Line | 4700 BROADWAY ST
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City | QUINCY
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State | IL
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Zip | 62305-9112
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Country | US
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Telephone | 217-222-2529
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Fax | 217-222-2895
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Authorized Official
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Title or Position | PREACHING MINISTER
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Name | DR. GLEN CHARLES SACKETT
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Credential | D. MIN.
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Telephone | 217-222-2529
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State |
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