Provider Demographics
NPI:1720318660
Name:BYKOTA CHURCH MINISTRIES
Entity Type:Organization
Organization Name:BYKOTA CHURCH MINISTRIES
Other - Org Name:LIFE TRANSFORMATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OF THE BOARD
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-358-3991
Mailing Address - Street 1:PO BOX 535
Mailing Address - Street 2:430 W. ELK
Mailing Address - City:CARTHAGE
Mailing Address - State:MO
Mailing Address - Zip Code:64836-0535
Mailing Address - Country:US
Mailing Address - Phone:417-358-3991
Mailing Address - Fax:417-358-7876
Practice Address - Street 1:430 W ELK ST
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:MO
Practice Address - Zip Code:64836-3607
Practice Address - Country:US
Practice Address - Phone:417-358-3991
Practice Address - Fax:417-358-7876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-27
Last Update Date:2009-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health