Provider Demographics
NPI:1629108873
Name:FIRST CHURCH OF GOD IN CHRIST INC
Entity Type:Organization
Organization Name:FIRST CHURCH OF GOD IN CHRIST INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BERNIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:CUNDIFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-760-4800
Mailing Address - Street 1:185 SARATOGA ST
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-6313
Mailing Address - Country:US
Mailing Address - Phone:336-760-4800
Mailing Address - Fax:
Practice Address - Street 1:185 SARATOGA ST
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-6313
Practice Address - Country:US
Practice Address - Phone:336-760-4800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children