Provider Demographics
NPI:1245897867
Name:GODS INCREDIBLE LIGHT ON THE PATH TO HIS WORD FELLOWSHIP CENTER
Entity type:Organization
Organization Name:GODS INCREDIBLE LIGHT ON THE PATH TO HIS WORD FELLOWSHIP CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR PASTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDROS
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEPPARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-830-0511
Mailing Address - Street 1:1759 COUNTY ROAD 486
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:TX
Mailing Address - Zip Code:77535-7968
Mailing Address - Country:US
Mailing Address - Phone:281-830-0511
Mailing Address - Fax:281-667-3116
Practice Address - Street 1:1759 COUNTY ROAD 486
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:TX
Practice Address - Zip Code:77535-7968
Practice Address - Country:US
Practice Address - Phone:281-830-0511
Practice Address - Fax:281-667-3116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-20
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health