Provider Demographics
NPI:1407621998
Name:LIFE KINGDOM OUTREACH MINISTRIES, INC.
Entity Type:Organization
Organization Name:LIFE KINGDOM OUTREACH MINISTRIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:GERALDINE
Authorized Official - Middle Name:
Authorized Official - Last Name:HANDY-MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-999-8734
Mailing Address - Street 1:1570 CHAPEL ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-4251
Mailing Address - Country:US
Mailing Address - Phone:203-999-8734
Mailing Address - Fax:
Practice Address - Street 1:1570 CHAPEL ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-4251
Practice Address - Country:US
Practice Address - Phone:203-999-8734
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-15
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty