Provider Demographics
NPI:1477964849
Name:LASTING LIFE MINISTRIES
Entity Type:Organization
Organization Name:LASTING LIFE MINISTRIES
Other - Org Name:AGAPE, REVELATION ALCOHOL AND DRUG FAITH BASED SERVICES AT CENTRAL KAN
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:BECKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-282-4014
Mailing Address - Street 1:2100 BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:GREAT BEND
Mailing Address - State:KS
Mailing Address - Zip Code:67530-4024
Mailing Address - Country:US
Mailing Address - Phone:620-282-4014
Mailing Address - Fax:620-603-6476
Practice Address - Street 1:2100 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:GREAT BEND
Practice Address - State:KS
Practice Address - Zip Code:67530-4024
Practice Address - Country:US
Practice Address - Phone:620-282-4014
Practice Address - Fax:620-603-6476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-19
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health