Provider Demographics
NPI:1871672295
Name:FREE WILL BAPTIST FAMILY MINISTRIES
Entity Type:Organization
Organization Name:FREE WILL BAPTIST FAMILY MINISTRIES
Other - Org Name:VICTORY BOYS' HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:KILGORE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:423-639-9449
Mailing Address - Street 1:844 VIRGINIA AVE NW
Mailing Address - Street 2:
Mailing Address - City:NORTON
Mailing Address - State:VA
Mailing Address - Zip Code:24273-1919
Mailing Address - Country:US
Mailing Address - Phone:276-679-7284
Mailing Address - Fax:276-670-0060
Practice Address - Street 1:844 VIRGINIA AVE NW
Practice Address - Street 2:
Practice Address - City:NORTON
Practice Address - State:VA
Practice Address - Zip Code:24273-1919
Practice Address - Country:US
Practice Address - Phone:276-679-7284
Practice Address - Fax:276-670-0060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VASS-139-05322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children