Provider Demographics
NPI:1093052359
Name:THIRD DAY MINISTRY
Entity Type:Organization
Organization Name:THIRD DAY MINISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:BERNITA
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:DOCTORATE DEGREE
Authorized Official - Phone:888-719-5445
Mailing Address - Street 1:2064 RIDGEDALE RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30317
Mailing Address - Country:US
Mailing Address - Phone:888-719-5445
Mailing Address - Fax:678-805-4743
Practice Address - Street 1:2064 RIDGEDALE RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30317
Practice Address - Country:US
Practice Address - Phone:888-719-5445
Practice Address - Fax:678-805-4743
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ON THE THIRD DAY CHRISTIAN MINISTRIES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-01-07
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN059388314000000X, 374K00000X, 374U00000X, 376J00000X, 376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing FacilityGroup - Multi-Specialty
No374K00000XNursing Service Related ProvidersReligious Nonmedical PractitionerGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GALPN059388OtherNURSING LICENSE