Provider Demographics
NPI:1770811556
Name:PIPELINE TO GOD COMMUNICATIONS, INC.
Entity type:Organization
Organization Name:PIPELINE TO GOD COMMUNICATIONS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:IRIS
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:M-DIV,, MA,, LPCC-S
Authorized Official - Phone:216-360-9343
Mailing Address - Street 1:23611 CHAGRIN BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5540
Mailing Address - Country:US
Mailing Address - Phone:216-360-9343
Mailing Address - Fax:216-360-9345
Practice Address - Street 1:23611 CHAGRIN BLVD STE 120
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5540
Practice Address - Country:US
Practice Address - Phone:216-360-9343
Practice Address - Fax:216-360-9345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-06
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1436740251V00000X
OH01-7543251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0055659Medicaid