Provider Demographics
NPI:1386183457
Name:GODS LOVE OUTREACH MINISTRIES
Entity Type:Organization
Organization Name:GODS LOVE OUTREACH MINISTRIES
Other - Org Name:G.L.O.M.
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-570-3282
Mailing Address - Street 1:851 RINCON AVE
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94551-6524
Mailing Address - Country:US
Mailing Address - Phone:925-443-3680
Mailing Address - Fax:925-443-3696
Practice Address - Street 1:851 RINCON AVE
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94551-6524
Practice Address - Country:US
Practice Address - Phone:925-443-3680
Practice Address - Fax:925-443-3696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-22
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA019200678320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness