Provider Demographics
NPI:1255739314
Name:BODY OF CHRIST ASSEMBLY
Entity type:Organization
Organization Name:BODY OF CHRIST ASSEMBLY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PASTOR/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:FREDRICK
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:EDDINGTON
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:469-261-0532
Mailing Address - Street 1:1614 SUMMER DR.
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104
Mailing Address - Country:US
Mailing Address - Phone:469-261-0532
Mailing Address - Fax:972-299-9369
Practice Address - Street 1:1614 SUMMERS DR
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-4920
Practice Address - Country:US
Practice Address - Phone:469-261-0532
Practice Address - Fax:972-299-9369
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BODY OF CHRIST ASSEMBLY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-12-05
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251B00000XAgenciesCase Management
No253Z00000XAgenciesIn Home Supportive Care