Provider Demographics
NPI:1033423835
Name:NEW BIRTH CHRISTIAN CENTER
Entity Type:Organization
Organization Name:NEW BIRTH CHRISTIAN CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PASTOR
Authorized Official - Phone:773-261-7404
Mailing Address - Street 1:5335 W LEMOYNE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60651-1326
Mailing Address - Country:US
Mailing Address - Phone:773-261-7404
Mailing Address - Fax:773-751-2250
Practice Address - Street 1:5335 LEMOYNE ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60651-1326
Practice Address - Country:US
Practice Address - Phone:773-261-7404
Practice Address - Fax:773-751-2250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-04
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty