MEDICARE: GOD'S HOUSE INTERNATIONAL, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP1600X	Pastoral Counselor

General Provider Information

NPI Number	:	1184495947
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOD'S HOUSE INTERNATIONAL, INC.

Provider Business Mailing Address
First Line	:	3005 LAKE AVE
Second Line	:
City	:	ALTADENA
State	:	CA
Zip	:	91001-1647
Country	:	US
Telephone Number	:	626-437-0919
Fax Number	:

Provider Business Practice Location Address
First Line	:	3005 LAKE AVE
Second Line	:
City	:	ALTADENA
State	:	CA
Zip	:	91001-1647
Country	:	US
Telephone Number	:	626-437-0919
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. MARK MACK THREATS
Credential	:
Telephone Number	:	626-437-0919

Provider Enumeration Date	:	01/11/2024
Last Update Date	:	01/11/2024

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Directions to “GOD'S HOUSE INTERNATIONAL, INC. ” Practice Location

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