Provider Demographics
NPI:1922576727
Name:JIREH CHRISTIAN CENTER
Entity Type:Organization
Organization Name:JIREH CHRISTIAN CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VERDALE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOINS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LPC
Authorized Official - Phone:346-874-7105
Mailing Address - Street 1:10701 CORPORATE DR STE 209
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-4050
Mailing Address - Country:US
Mailing Address - Phone:346-874-7105
Mailing Address - Fax:346-874-7106
Practice Address - Street 1:10701 CORPORATE DR STE 209
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-4050
Practice Address - Country:US
Practice Address - Phone:346-874-7105
Practice Address - Fax:346-874-7105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-09
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX374557201Medicaid