Provider Demographics
NPI:1578931424
Name:2ND CORINTHIANS OUTREACH MINISTRIES INC.
Entity Type:Organization
Organization Name:2ND CORINTHIANS OUTREACH MINISTRIES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLERMINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:772-940-6755
Mailing Address - Street 1:3680 SE GATEHOUSE CIR APT 236
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-5036
Mailing Address - Country:US
Mailing Address - Phone:772-940-6755
Mailing Address - Fax:
Practice Address - Street 1:3680 SE GATEHOUSE CIR APT 236
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-5036
Practice Address - Country:US
Practice Address - Phone:772-940-6755
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-09
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)Group - Single Specialty
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
No347C00000XTransportation ServicesPrivate VehicleGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1578931424Medicaid