Provider Demographics
NPI:1407209109
Name:SHEPHERDS BAPTIST MINISTRIES INC
Entity Type:Organization
Organization Name:SHEPHERDS BAPTIST MINISTRIES INC
Other - Org Name:SHEPHERDS MINISTRIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:KARYN
Authorized Official - Middle Name:
Authorized Official - Last Name:BORUCKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-878-5620
Mailing Address - Street 1:1805 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:UNION GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53182-1527
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1805 15TH AVE
Practice Address - Street 2:
Practice Address - City:UNION GROVE
Practice Address - State:WI
Practice Address - Zip Code:53182-1527
Practice Address - Country:US
Practice Address - Phone:262-878-5620
Practice Address - Fax:262-878-9285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-18
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities