Provider Demographics
NPI:1255973566
Name:REHOBOTH LIFE CARE MINISTRIES, INC
Entity type:Organization
Organization Name:REHOBOTH LIFE CARE MINISTRIES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:HODGES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-953-7770
Mailing Address - Street 1:3208 HWY 41
Mailing Address - Street 2:BYRON
Mailing Address - City:BYRON
Mailing Address - State:GA
Mailing Address - Zip Code:31008
Mailing Address - Country:US
Mailing Address - Phone:478-953-7770
Mailing Address - Fax:478-953-7771
Practice Address - Street 1:3208 HWY 41
Practice Address - Street 2:BYRON
Practice Address - City:BYRON
Practice Address - State:GA
Practice Address - Zip Code:31008
Practice Address - Country:US
Practice Address - Phone:478-953-7770
Practice Address - Fax:478-953-7771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-09
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty