Provider Demographics
NPI:1215196365
Name:CENTRAL PARK CHURCH OF GOD
Entity Type:Organization
Organization Name:CENTRAL PARK CHURCH OF GOD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TEACHER
Authorized Official - Prefix:MS
Authorized Official - First Name:EVANGELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:VARGAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-358-7577
Mailing Address - Street 1:3341 ELM GROVE RD
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-6371
Mailing Address - Country:US
Mailing Address - Phone:972-358-7577
Mailing Address - Fax:
Practice Address - Street 1:3341 ELM GROVE RD
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-6371
Practice Address - Country:US
Practice Address - Phone:972-358-7577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-04
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty