Provider Demographics
NPI:1639665516
Name:TRAINING CENTER EPHESIANS 4:11-16
Entity Type:Organization
Organization Name:TRAINING CENTER EPHESIANS 4:11-16
Other - Org Name:TRAINING CENTER EPHESIANS
Other - Org Type:Other Name
Authorized Official - Title/Position:CENTER MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:LAZARUS
Authorized Official - Suffix:
Authorized Official - Credentials:CATC-II
Authorized Official - Phone:619-327-5400
Mailing Address - Street 1:525 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91977-5933
Mailing Address - Country:US
Mailing Address - Phone:619-327-5400
Mailing Address - Fax:619-324-5410
Practice Address - Street 1:525 GRAND AVE
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91977-5933
Practice Address - Country:US
Practice Address - Phone:619-327-5400
Practice Address - Fax:619-324-5410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-03
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility