Provider Demographics
NPI:1467819326
Name:JESUS 911 COMMUNITY MINISTRIERS
Entity Type:Organization
Organization Name:JESUS 911 COMMUNITY MINISTRIERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:KIETH
Authorized Official - Last Name:LOMAS
Authorized Official - Suffix:I
Authorized Official - Credentials:PASTOR
Authorized Official - Phone:419-330-4102
Mailing Address - Street 1:418 BIRCH ST
Mailing Address - Street 2:
Mailing Address - City:WAUSEON
Mailing Address - State:OH
Mailing Address - Zip Code:43567-1409
Mailing Address - Country:US
Mailing Address - Phone:419-330-4102
Mailing Address - Fax:
Practice Address - Street 1:418 BIRCH ST
Practice Address - Street 2:
Practice Address - City:WAUSEON
Practice Address - State:OH
Practice Address - Zip Code:43567-1409
Practice Address - Country:US
Practice Address - Phone:419-330-4102
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-24
Last Update Date:2016-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH141666305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization