Provider Demographics
NPI:1326285081
Name:CHURCH OF ACTS FELLOWSHIP INTL INC
Entity Type:Organization
Organization Name:CHURCH OF ACTS FELLOWSHIP INTL INC
Other - Org Name:FACING REALITY PROGRAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:C.E.O/CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:GARDNER
Authorized Official - Middle Name:G
Authorized Official - Last Name:YATES
Authorized Official - Suffix:
Authorized Official - Credentials:CLERGY
Authorized Official - Phone:502-330-9055
Mailing Address - Street 1:114 VALLEY BROOK DR
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40601-4263
Mailing Address - Country:US
Mailing Address - Phone:502-330-9055
Mailing Address - Fax:
Practice Address - Street 1:114 VALLEY BROOK DR
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-4263
Practice Address - Country:US
Practice Address - Phone:502-330-9055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-16
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No251C00000XAgenciesDay Training, Developmentally Disabled Services