Provider Demographics
NPI:1518405083
Name:CHRISTIAN COMMUNITY DELIVERANCE CHURCH
Entity Type:Organization
Organization Name:CHRISTIAN COMMUNITY DELIVERANCE CHURCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRSIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MILLICENT
Authorized Official - Middle Name:
Authorized Official - Last Name:SAWYERR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-275-5132
Mailing Address - Street 1:13421 CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-8530
Mailing Address - Country:US
Mailing Address - Phone:612-275-5132
Mailing Address - Fax:
Practice Address - Street 1:13421 CEDAR AVE
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-8530
Practice Address - Country:US
Practice Address - Phone:612-275-5132
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-05
Last Update Date:2017-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4315251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health