Provider Demographics
NPI:1710100078
Name:POWER & PRAISE TABERNACLE
Entity Type:Organization
Organization Name:POWER & PRAISE TABERNACLE
Other - Org Name:AS IT IS IN HEAVEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAKESIA
Authorized Official - Middle Name:T
Authorized Official - Last Name:MARSHALL BATTLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-887-2057
Mailing Address - Street 1:807 VAIL AVE
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27260
Mailing Address - Country:US
Mailing Address - Phone:336-887-2057
Mailing Address - Fax:336-887-4513
Practice Address - Street 1:807 VAIL AVE
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27260
Practice Address - Country:US
Practice Address - Phone:336-887-2057
Practice Address - Fax:336-887-4513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL041056311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7805578Medicaid