Provider Demographics
NPI:1952634727
Name:FAMILY OF GOD CHURCH
Entity Type:Organization
Organization Name:FAMILY OF GOD CHURCH
Other - Org Name:GOD'S RESOURCES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MINISTER
Authorized Official - Prefix:
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:F
Authorized Official - Last Name:BURDICK
Authorized Official - Suffix:
Authorized Official - Credentials:REVERAND
Authorized Official - Phone:307-277-6492
Mailing Address - Street 1:1900 S MISSOURI AVE
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609-3308
Mailing Address - Country:US
Mailing Address - Phone:307-277-6492
Mailing Address - Fax:
Practice Address - Street 1:4300 S POPLAR ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-6107
Practice Address - Country:US
Practice Address - Phone:307-277-6492
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-11
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services