Provider Demographics
NPI:1225389521
Name:SET THE CAPTIVES DELIVERANCE MINISTRY
Entity Type:Organization
Organization Name:SET THE CAPTIVES DELIVERANCE MINISTRY
Other - Org Name:ST. PAUL CENTER ALCOHOL AND DRUIG PROGRAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLAIBORNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-908-3856
Mailing Address - Street 1:1039 W FLORENCE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90044-2441
Mailing Address - Country:US
Mailing Address - Phone:310-908-3856
Mailing Address - Fax:301-961-3658
Practice Address - Street 1:1039 W FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90044-2441
Practice Address - Country:US
Practice Address - Phone:310-908-3856
Practice Address - Fax:301-961-3658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-26
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health