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General NPI Number Information
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NPI Number | 1760163083
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Entity Type | Organization
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Legal Business Name | NEW REVELATION OF CHRIST CHURCH MINISTRIES
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Dates
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Enumeration Date | 07/28/2023
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Last Update Date | 07/28/2023
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Provider Practice Location Address
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Address Line | 4018 QUAIL BUSH DR
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City | DAYTON
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State | OH
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Zip | 45424-4740
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Country | US
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Telephone | 937-305-0024
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Fax |
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Provider Business Mailing Address
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Address Line | 4018 QUAIL BUSH DR
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City | DAYTON
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State | OH
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Zip | 45424-4740
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Country | US
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Telephone | 937-305-0024
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Fax |
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Authorized Official
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Title or Position | PASTOR
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Name | CORDELL M MITCHELL
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Credential | ORDAINED MINISTER
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Telephone | 937-305-0024
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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 | 251K00000X
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Taxonomy Name | Public Health or Welfare 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 | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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