Provider Demographics
NPI:1619634078
Name:THE DELIVERANCE OVERCOMING CHURCH OF GOD
Entity Type:Organization
Organization Name:THE DELIVERANCE OVERCOMING CHURCH OF GOD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO / SENIOR PASTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDRAE
Authorized Official - Middle Name:D
Authorized Official - Last Name:MAZE
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:216-287-5031
Mailing Address - Street 1:PO BOX 1945
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44258-1945
Mailing Address - Country:US
Mailing Address - Phone:216-391-7289
Mailing Address - Fax:
Practice Address - Street 1:7201 QUINCY AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44104-1942
Practice Address - Country:US
Practice Address - Phone:216-391-7289
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-19
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374K00000XNursing Service Related ProvidersReligious Nonmedical PractitionerGroup - Multi-Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty