Provider Demographics
NPI:1346937745
Name:FIX YOUR CROWN FOUNDATION
Entity Type:Organization
Organization Name:FIX YOUR CROWN FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-215-2860
Mailing Address - Street 1:8656 HIGHWAY 165 N APT 16
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-8709
Mailing Address - Country:US
Mailing Address - Phone:682-215-2860
Mailing Address - Fax:
Practice Address - Street 1:8656 HIGHWAY 165 N APT 16
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-8709
Practice Address - Country:US
Practice Address - Phone:682-215-2860
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-18
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282J00000XHospitalsReligious Nonmedical Health Care Institution
No251B00000XAgenciesCase Management