Provider Demographics
NPI:1891286266
Name:INTERNATIONAL WORD OUT MINISTRIES
Entity Type:Organization
Organization Name:INTERNATIONAL WORD OUT MINISTRIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:YASMEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:STURDIVANT
Authorized Official - Suffix:
Authorized Official - Credentials:TH M
Authorized Official - Phone:708-663-2615
Mailing Address - Street 1:23820 S SARA CT
Mailing Address - Street 2:
Mailing Address - City:CRETE
Mailing Address - State:IL
Mailing Address - Zip Code:60417-3412
Mailing Address - Country:US
Mailing Address - Phone:708-663-2615
Mailing Address - Fax:
Practice Address - Street 1:1139 W VERMONT AVE
Practice Address - Street 2:
Practice Address - City:CALUMET PARK
Practice Address - State:IL
Practice Address - Zip Code:60827-6520
Practice Address - Country:US
Practice Address - Phone:708-897-9446
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-22
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILA74870002A276400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit