Provider Demographics
NPI:1174815583
Name:LAMB OF GOD MINISTRIES INCORPORATED
Entity Type:Organization
Organization Name:LAMB OF GOD MINISTRIES INCORPORATED
Other - Org Name:LAMB OF GOD RECOVERY CENTERS, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LYLE
Authorized Official - Middle Name:R
Authorized Official - Last Name:FRIED
Authorized Official - Suffix:
Authorized Official - Credentials:CAP
Authorized Official - Phone:863-467-2677
Mailing Address - Street 1:1012 S PARROTT AVE
Mailing Address - Street 2:
Mailing Address - City:OKEECHOBEE
Mailing Address - State:FL
Mailing Address - Zip Code:34974-5268
Mailing Address - Country:US
Mailing Address - Phone:863-467-2677
Mailing Address - Fax:863-467-0677
Practice Address - Street 1:1012 S PARROTT AVE
Practice Address - Street 2:
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34974-5268
Practice Address - Country:US
Practice Address - Phone:863-467-2677
Practice Address - Fax:863-467-0677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-04
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1947AD975000324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility