Provider Demographics
NPI:1326468414
Name:WORD OF LIFE EVANGELISTIC MINISTRY
Entity Type:Organization
Organization Name:WORD OF LIFE EVANGELISTIC MINISTRY
Other - Org Name:WORD OF LIFE MINISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BYNUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-233-1988
Mailing Address - Street 1:2848 MARIPOSA ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93721-1308
Mailing Address - Country:US
Mailing Address - Phone:559-233-1988
Mailing Address - Fax:559-233-1989
Practice Address - Street 1:2848 MARIPOSA ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93721-1308
Practice Address - Country:US
Practice Address - Phone:559-233-1988
Practice Address - Fax:559-233-1989
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WORD OF LIFE EVANGELISTIC MINISTRY, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-04-16
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2424153245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children