MEDICARE: THE GAQTHERING PLACE LIONHEART MINISTRIES 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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1437554714
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE GAQTHERING PLACE LIONHEART MINISTRIES INC

Provider Business Mailing Address
First Line	:	9345 DRAGON TREE DR
Second Line	:
City	:	HESPERIA
State	:	CA
Zip	:	92344-4680
Country	:	US
Telephone Number	:	760-948-9930
Fax Number	:

Provider Business Practice Location Address
First Line	:	9345 DRAGON TREE DR
Second Line	:
City	:	HESPERIA
State	:	CA
Zip	:	92344-4680
Country	:	US
Telephone Number	:	760-948-9930
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. DEYLYNE BRUCE MCCAMPBELL SR.
Credential	:
Telephone Number	:	951-536-1238

Provider Enumeration Date	:	10/28/2014
Last Update Date	:	10/28/2014

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