Provider Demographics
NPI:1598156002
Name:CHRIST THE KING FAITH TEMPLE MINISTRIES
Entity Type:Organization
Organization Name:CHRIST THE KING FAITH TEMPLE MINISTRIES
Other - Org Name:LIFE SUPPORT ADDICTION SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO/FOUNDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:304-374-0734
Mailing Address - Street 1:73 EAST ST.
Mailing Address - Street 2:
Mailing Address - City:NEW CUMBERLAND
Mailing Address - State:WV
Mailing Address - Zip Code:26047-1503
Mailing Address - Country:US
Mailing Address - Phone:740-275-6077
Mailing Address - Fax:
Practice Address - Street 1:3176 WEIR AVE
Practice Address - Street 2:
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062-4809
Practice Address - Country:US
Practice Address - Phone:304-224-1060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-05
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1302076104100000X
OH269712163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty