Provider Demographics
NPI:1558303289
Name:THE WORD OF GOD CHRISTIAN CENTRE, INC.
Entity Type:Organization
Organization Name:THE WORD OF GOD CHRISTIAN CENTRE, INC.
Other - Org Name:YOUTH ENVISIONING SUCESS(YES) ACADEMY, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DWIGHT
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:954-822-2481
Mailing Address - Street 1:8066 VIA BOLZANO
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-5232
Mailing Address - Country:US
Mailing Address - Phone:954-822-2481
Mailing Address - Fax:954-206-0910
Practice Address - Street 1:7501 NW 4TH ST
Practice Address - Street 2:SUITE 212B
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-2245
Practice Address - Country:US
Practice Address - Phone:954-822-2481
Practice Address - Fax:954-206-0910
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE WORD OF GOD CHRISTIAN CENTRE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-10
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299992938251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL690341069Medicaid