Provider Demographics
NPI:1740564699
Name:TEMPLE OF THE LORD OUTREACH
Entity Type:Organization
Organization Name:TEMPLE OF THE LORD OUTREACH
Other - Org Name:AGAPE HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:702-401-9314
Mailing Address - Street 1:94 ANCIENT HILLS LN
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-1750
Mailing Address - Country:US
Mailing Address - Phone:702-401-9314
Mailing Address - Fax:702-465-6845
Practice Address - Street 1:94 ANCIENT HILLS LN
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-1750
Practice Address - Country:US
Practice Address - Phone:702-401-9314
Practice Address - Fax:702-475-6845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-10
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty