MEDICARE: NEW REVELATION OF CHRIST CHURCH MINISTRIES

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251B00000X	Case Management Agency
2	251K00000X	Public Health or Welfare Agency
3	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1760163083
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW REVELATION OF CHRIST CHURCH MINISTRIES

Provider Business Mailing Address
First Line	:	4018 QUAIL BUSH DR
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45424-4740
Country	:	US
Telephone Number	:	937-305-0024
Fax Number	:

Provider Business Practice Location Address
First Line	:	4018 QUAIL BUSH DR
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45424-4740
Country	:	US
Telephone Number	:	937-305-0024
Fax Number	:

Authorized Official
Title or Position	:	PASTOR
Name	:	CORDELL M MITCHELL
Credential	:	ORDAINED MINISTER
Telephone Number	:	937-305-0024

Provider Enumeration Date	:	07/28/2023
Last Update Date	:	07/28/2023

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Directions to “NEW REVELATION OF CHRIST CHURCH MINISTRIES ” Practice Location

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