Provider Demographics
NPI:1275233090
Name:CHURCH OF GOD'S WORD
Entity Type:Organization
Organization Name:CHURCH OF GOD'S WORD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PASTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:EMMA
Authorized Official - Last Name:BUCHHOLZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-412-3972
Mailing Address - Street 1:227 MAIN AVE W
Mailing Address - Street 2:
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-1725
Mailing Address - Country:US
Mailing Address - Phone:701-639-6240
Mailing Address - Fax:
Practice Address - Street 1:227 MAIN AVE W
Practice Address - Street 2:
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078-1725
Practice Address - Country:US
Practice Address - Phone:701-639-6240
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-09
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health