Provider Demographics
NPI:1073800322
Name:EXPRESSIONS OF FAITH, INCORPORATED
Entity Type:Organization
Organization Name:EXPRESSIONS OF FAITH, INCORPORATED
Other - Org Name:THE OLD SCHOOL
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:GATES-BURKLOW
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:618-549-1870
Mailing Address - Street 1:PO BOX 234
Mailing Address - Street 2:200 N. SPRINGER ST.
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62903-0234
Mailing Address - Country:US
Mailing Address - Phone:618-549-1870
Mailing Address - Fax:618-549-1870
Practice Address - Street 1:200 N SPRINGER ST
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-1426
Practice Address - Country:US
Practice Address - Phone:618-549-1870
Practice Address - Fax:618-549-1870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-07
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171R00000XOther Service ProvidersInterpreterGroup - Single Specialty