Provider Demographics
NPI:1396942348
Name:LIFE CHRISTIAN OUTREACH
Entity type:Organization
Organization Name:LIFE CHRISTIAN OUTREACH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:ORDWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-336-8831
Mailing Address - Street 1:106 GALEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BRANSON
Mailing Address - State:MO
Mailing Address - Zip Code:65616-7289
Mailing Address - Country:US
Mailing Address - Phone:417-336-8831
Mailing Address - Fax:417-336-0813
Practice Address - Street 1:106 GALEWOOD DR
Practice Address - Street 2:
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-7289
Practice Address - Country:US
Practice Address - Phone:417-336-8831
Practice Address - Fax:417-336-0813
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFE CHRISTIAN OUTREACH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-02
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child