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General NPI Number Information
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NPI Number | 1679714810
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Entity Type | Organization
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Legal Business Name | PRAISE THE LORD MINISTRY
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Dates
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Enumeration Date | 03/18/2009
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Last Update Date | 03/18/2009
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Provider Practice Location Address
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Address Line | 338 RHEW ST
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City | FAYETTEVILLE
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State | NC
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Zip | 28303-3354
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Country | US
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Telephone | 910-425-3640
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Fax | 910-425-0150
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Provider Business Mailing Address
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Address Line | 338 RHEW ST
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City | FAYETTEVILLE
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State | NC
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Zip | 28303-3354
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Country | US
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Telephone | 910-425-3640
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Fax | 910-425-0150
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Authorized Official
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Title or Position | OFFICER MANAGER
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Name | MR. TYRONE JOHNSON
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Credential |
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Telephone | 941-425-3640
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | HC2573
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License Number State | NC
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