Provider Demographics
NPI:1275221046
Name:TRUE DISCIPLES OF JESUS CHRIST OUT REACH MINISTRY INC.
Entity Type:Organization
Organization Name:TRUE DISCIPLES OF JESUS CHRIST OUT REACH MINISTRY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TERAIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-430-7710
Mailing Address - Street 1:811 CHANNING RD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-3709
Mailing Address - Country:US
Mailing Address - Phone:863-430-7710
Mailing Address - Fax:
Practice Address - Street 1:811 CHANNING RD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-3709
Practice Address - Country:US
Practice Address - Phone:863-430-7710
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-28
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services