Provider Demographics
NPI:1558071126
Name:THE LORD'S GYM VANCOUVER USA
Entity Type:Organization
Organization Name:THE LORD'S GYM VANCOUVER USA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOOKKEEPER/TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-903-3911
Mailing Address - Street 1:P.O. BOX 2275
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98668
Mailing Address - Country:US
Mailing Address - Phone:360-718-7279
Mailing Address - Fax:
Practice Address - Street 1:2410 GRAND BLVD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661
Practice Address - Country:US
Practice Address - Phone:360-718-7279
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management