Provider Demographics
NPI:1124492053
Name:CHRIST AMBASSADORS CHURCH INC
Entity type:Organization
Organization Name:CHRIST AMBASSADORS CHURCH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:CLEVER
Authorized Official - Middle Name:
Authorized Official - Last Name:UGBODU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-772-0597
Mailing Address - Street 1:2270 LOSEE RD
Mailing Address - Street 2:
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89030-4109
Mailing Address - Country:US
Mailing Address - Phone:702-772-3663
Mailing Address - Fax:
Practice Address - Street 1:2270 LOSEE RD
Practice Address - Street 2:
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-4109
Practice Address - Country:US
Practice Address - Phone:702-772-3663
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-16
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health