Provider Demographics
NPI:1326104720
Name:CHRISTIAN MINISTRIES VOLUNTEER ORGANIZATION
Entity Type:Organization
Organization Name:CHRISTIAN MINISTRIES VOLUNTEER ORGANIZATION
Other - Org Name:VICTORIAN MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ODOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-227-9222
Mailing Address - Street 1:121 W COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30224-4220
Mailing Address - Country:US
Mailing Address - Phone:770-233-0400
Mailing Address - Fax:770-233-4441
Practice Address - Street 1:630 MERIWETHER ST
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224-4139
Practice Address - Country:US
Practice Address - Phone:770-233-8116
Practice Address - Fax:770-233-8482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility