Provider Demographics
NPI:1023394186
Name:FREE WILL BAPTIST FAMILY MINISTRIES, INC.
Entity Type:Organization
Organization Name:FREE WILL BAPTIST FAMILY MINISTRIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:HAROLD
Authorized Official - Last Name:KILGORE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:423-639-9449
Mailing Address - Street 1:90 STANLEY LN
Mailing Address - Street 2:
Mailing Address - City:GREENEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37743-6066
Mailing Address - Country:US
Mailing Address - Phone:423-639-9449
Mailing Address - Fax:423-639-5083
Practice Address - Street 1:90 STANLEY LN
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37743-6066
Practice Address - Country:US
Practice Address - Phone:423-639-9449
Practice Address - Fax:423-639-5083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-02
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNSO10855A320800000X
TNL0000000078203245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children