=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831074566
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TEMPLE OF HUMAN SPIRITUALITY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/11/2025
-----------------------------------------------------
Last Update Date | 08/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 528 W 35TH ST
-----------------------------------------------------
City | NORFOLK
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23508-3102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-298-7428
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3535 TIDEWATER DR STE B
-----------------------------------------------------
City | NORFOLK
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23509-1333
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-994-2253
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | TRUSTEE/MINISTER
-----------------------------------------------------
Name | MARVIN ELLIS
-----------------------------------------------------
Credential | DD
-----------------------------------------------------
Telephone | 757-994-2253
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251V00000X
-----------------------------------------------------
Taxonomy Name | Voluntary or Charitable Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 282J00000X
-----------------------------------------------------
Taxonomy Name | Religious Nonmedical Health Care Institution
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------