1851555999 NPI number — WINGS OF GRACE CHRISTIAN MINISTRIES, INC.

Table of content: (NPI 1851555999)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851555999 NPI number — WINGS OF GRACE CHRISTIAN MINISTRIES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WINGS OF GRACE CHRISTIAN 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:
WINGS OF GRACE COUNSELING SERVICES
Provider Other Organization Name Type Code:
3
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:
1851555999
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/13/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4585 HILTON PKWY
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
COLORADO SPRINGS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80907-3569
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-600-1088
Provider Business Mailing Address Fax Number:
719-599-4693

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4585 HILTON PKWY
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
COLORADO SPRINGS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80907-3569
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-600-1088
Provider Business Practice Location Address Fax Number:
719-599-4693
Provider Enumeration Date:
07/17/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BIRD
Authorized Official First Name:
BRADLEY
Authorized Official Middle Name:
T
Authorized Official Title or Position:
DIRECTOR OF STRATEGY & DEVELOPMENT
Authorized Official Telephone Number:
888-600-1088

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  10180 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: 10195 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: 7995 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 482 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 4722 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 4496 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 764 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 6802057778 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X , with the licence number: 268 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 106H00000X , with the licence number: 659 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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