1265439889 NPI number — IMMANUEL CARING MINISTRIES, INC.

Table of content: (NPI 1265439889)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265439889 NPI number — IMMANUEL CARING MINISTRIES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IMMANUEL CARING MINISTRIES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
IMMANUEL CAMPUS OF CARE
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265439889
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/16/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11301 N 99TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PEORIA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85345-5466
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
623-977-8373
Provider Business Mailing Address Fax Number:
623-974-4849

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11301 N 99TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEORIA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85345-5466
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-977-8373
Provider Business Practice Location Address Fax Number:
623-974-4849
Provider Enumeration Date:
06/29/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BYRUM-NIELSEN
Authorized Official First Name:
BARBARA
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
DIRECTOR OF FINANCE
Authorized Official Telephone Number:
623-977-8373

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  ALC4369 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 314000000X , with the licence number: NCI066 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 447591 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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