Provider Demographics
NPI:1851561351
Name:WOMEN IN CRISIS OUTREACH MINISTRY & SHELTER INC.
Entity Type:Organization
Organization Name:WOMEN IN CRISIS OUTREACH MINISTRY & SHELTER INC.
Other - Org Name:WOMEN IN CRISIS INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:C.E.O./PASTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:RANDOLPH
Authorized Official - Suffix:
Authorized Official - Credentials:BISHOP
Authorized Official - Phone:251-649-9440
Mailing Address - Street 1:9030 BROADUS LOOP RD
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36613-9616
Mailing Address - Country:US
Mailing Address - Phone:251-649-9440
Mailing Address - Fax:
Practice Address - Street 1:9030 BROADUS LOOP RD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36613-9616
Practice Address - Country:US
Practice Address - Phone:251-649-9440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-11
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL253Z00000X, 302R00000X, 310400000X, 320700000X, 347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No253Z00000XAgenciesIn Home Supportive Care
No302R00000XManaged Care OrganizationsHealth Maintenance Organization
No320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
No347C00000XTransportation ServicesPrivate Vehicle