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General NPI Number Information
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NPI Number | 1952682247
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Entity Type | Organization
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Legal Business Name | BREAKTHROUGH REVIVAL PENTECOSTAL HOLINESS CHURCH
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Dates
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Enumeration Date | 08/31/2011
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Last Update Date | 08/31/2011
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Provider Practice Location Address
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Address Line | 210 CHURCH ST
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City | GREENVILLE
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State | NC
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Zip | 27834-1212
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Country | US
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Telephone | 252-985-1875
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Fax | 252-399-0526
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Provider Business Mailing Address
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Address Line | PO BOX 31026
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City | GREENVILLE
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State | NC
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Zip | 27833-1026
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Country | US
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Telephone | 252-985-1875
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Fax | 252-399-0526
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. LYDIA K JONES
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Credential |
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Telephone | 252-985-1875
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health 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 | 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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