1326656257 NPI number — SHEKINAH GLORY HOUSE OF REFUGE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326656257 NPI number — SHEKINAH GLORY HOUSE OF REFUGE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHEKINAH GLORY HOUSE OF REFUGE
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:
Provider Other Organization Name Type Code:
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:
1326656257
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/18/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2400 GOLDENMOON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89108-4477
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-790-2977
Provider Business Mailing Address Fax Number:
725-251-6664

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6018 SMOKE RANCH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89108-3700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-790-2977
Provider Business Practice Location Address Fax Number:
725-251-6664
Provider Enumeration Date:
07/16/2020

Additional Information

Authorized Official

Authorized Official Last Name:
GRAY
Authorized Official First Name:
LILLIAN
Authorized Official Middle Name:
KATHERINE
Authorized Official Title or Position:
OFFICE ADMINISTRATOR
Authorized Official Telephone Number:
702-790-2977

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com