Provider Demographics
NPI:1922887025
Name:IMMANUEL LUTHERAN CHURCH
Entity Type:Organization
Organization Name:IMMANUEL LUTHERAN CHURCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-451-4929
Mailing Address - Street 1:500 IMMANUEL RD STE B
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-8344
Mailing Address - Country:US
Mailing Address - Phone:512-251-4929
Mailing Address - Fax:
Practice Address - Street 1:500 IMMANUEL RD STE B
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-8344
Practice Address - Country:US
Practice Address - Phone:512-251-4929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IMMANUEL LUTHERAN CHURCH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-09-27
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)