Provider Demographics
NPI:1083900120
Name:MY FATHER'S HOUSE INC., PRENATAL & RESOURCE CENTER
Entity Type:Organization
Organization Name:MY FATHER'S HOUSE INC., PRENATAL & RESOURCE CENTER
Other - Org Name:INTERNATIONAL GOSPEL FELLOWSHIP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FELICIA
Authorized Official - Middle Name:SHANTELL
Authorized Official - Last Name:STEVENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-240-6339
Mailing Address - Street 1:101 MEDICAL COURT, SUITE 212
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401
Mailing Address - Country:US
Mailing Address - Phone:304-885-0017
Mailing Address - Fax:304-932-0831
Practice Address - Street 1:101 MEDICAL CT STE 212
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-3854
Practice Address - Country:US
Practice Address - Phone:304-885-0017
Practice Address - Fax:304-932-0831
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FULL GOSPEL OF CHRIST FELLOWSHIP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-06-28
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management