Provider Demographics
NPI:1790448629
Name:NORTHDAVIDSON A UNITED METHODIST CONGREGATION
Entity Type:Organization
Organization Name:NORTHDAVIDSON A UNITED METHODIST CONGREGATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LEAD PASTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:SHANKA
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:SR
Authorized Official - Credentials:DOCTOR OF DIVINITY
Authorized Official - Phone:704-806-3803
Mailing Address - Street 1:3400 WINTERFIELD PL
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-5940
Mailing Address - Country:US
Mailing Address - Phone:704-806-3803
Mailing Address - Fax:
Practice Address - Street 1:1025 E 36TH ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-1652
Practice Address - Country:US
Practice Address - Phone:704-806-3803
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-18
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC34D2236552OtherCLIA