Provider Demographics
NPI:1538469143
Name:HOUSE OF PRAYER
Entity Type:Organization
Organization Name:HOUSE OF PRAYER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MUNGUIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-792-3462
Mailing Address - Street 1:925 E 30TH ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85713-3605
Mailing Address - Country:US
Mailing Address - Phone:520-792-3462
Mailing Address - Fax:520-624-7955
Practice Address - Street 1:919 E 30TH ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85713-3605
Practice Address - Country:US
Practice Address - Phone:520-792-3462
Practice Address - Fax:520-624-7955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-28
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL6429H311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
987654321OtherSECRET CODE