MEDICARE: DOMINION MINISTRIES

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	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245425156
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOMINION MINISTRIES

Provider Business Mailing Address
First Line	:	1530 N GREGSON ST
Second Line	:	SUITE 3D
City	:	DURHAM
State	:	NC
Zip	:	27701-1155
Country	:	US
Telephone Number	:	919-416-1830
Fax Number	:	919-416-8883

Provider Business Practice Location Address
First Line	:	1530 N GREGSON ST
Second Line	:	SUITE 3D
City	:	DURHAM
State	:	NC
Zip	:	27701-1155
Country	:	US
Telephone Number	:	919-416-1830
Fax Number	:	919-416-8883

Authorized Official
Title or Position	:	EXECUTIVE ASSISTANT
Name	:	MRS. CYNTHIA DENNIS JOHNSON
Credential	:
Telephone Number	:	919-416-1830

Provider Enumeration Date	:	09/13/2007
Last Update Date	:	09/13/2007

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Directions to “DOMINION MINISTRIES ” Practice Location

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