Provider Demographics
NPI:1427569896
Name:A CHURCH FOR US
Entity Type:Organization
Organization Name:A CHURCH FOR US
Other - Org Name:A CHURCH FOR ALL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:DORETHA
Authorized Official - Middle Name:FAYE
Authorized Official - Last Name:WILLIAMS-FLOURNOY
Authorized Official - Suffix:
Authorized Official - Credentials:REV
Authorized Official - Phone:916-541-1762
Mailing Address - Street 1:4704 ROSEVILLE RD STE 110
Mailing Address - Street 2:
Mailing Address - City:NORTH HIGHLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:95660-5173
Mailing Address - Country:US
Mailing Address - Phone:916-807-7305
Mailing Address - Fax:
Practice Address - Street 1:4704 ROSEVILLE RD STE 110
Practice Address - Street 2:
Practice Address - City:NORTH HIGHLANDS
Practice Address - State:CA
Practice Address - Zip Code:95660-5173
Practice Address - Country:US
Practice Address - Phone:916-807-7305
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-12
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care