Provider Demographics
NPI:1659507010
Name:SECOND BAPTIST CHURCH
Entity Type:Organization
Organization Name:SECOND BAPTIST CHURCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:317-925-0335
Mailing Address - Street 1:3705 KESSLER BLVD NORTH DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46222-5800
Mailing Address - Country:US
Mailing Address - Phone:317-925-0335
Mailing Address - Fax:317-925-3922
Practice Address - Street 1:3705 KESSLER BLVD NORTH DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46222-5800
Practice Address - Country:US
Practice Address - Phone:317-925-0335
Practice Address - Fax:317-925-3922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-29
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN200937220A253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency