Provider Demographics
NPI:1396979472
Name:EVENTIDE MINITRIES
Entity type:Organization
Organization Name:EVENTIDE MINITRIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:DANYFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-850-4096
Mailing Address - Street 1:3003 SOUTH COUNTRY CLUB RD.
Mailing Address - Street 2:SUITE 277
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85713
Mailing Address - Country:US
Mailing Address - Phone:520-622-0525
Mailing Address - Fax:
Practice Address - Street 1:3003 S COUNTRY CLUB RD
Practice Address - Street 2:SUITE 277
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85713-4082
Practice Address - Country:US
Practice Address - Phone:520-622-0525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-05
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ174400000XOtherSPECIALIST