1639665516 NPI number — TRAINING CENTER EPHESIANS 4:11-16

Table of content: MS. KATHRYN ANNE MOORE LMP (NPI 1841424652)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639665516 NPI number — TRAINING CENTER EPHESIANS 4:11-16

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRAINING CENTER EPHESIANS 4:11-16
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:
6
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:
1639665516
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/23/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
525 GRAND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRING VALLEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91977-5933
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-327-5400
Provider Business Mailing Address Fax Number:
619-324-5410

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
525 GRAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRING VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91977-5933
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-327-5400
Provider Business Practice Location Address Fax Number:
619-324-5410
Provider Enumeration Date:
07/03/2018

Additional Information

Authorized Official

Authorized Official Last Name:
LAZARUS
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
ALAN
Authorized Official Title or Position:
CENTER MANAGER
Authorized Official Telephone Number:
619-327-5400

Provider Taxonomy Codes

  • Taxonomy code: 324500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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