Provider Demographics
NPI:1770880676
Name:BERACHAH MINISTRY
Entity type:Organization
Organization Name:BERACHAH MINISTRY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BULLOCK-BLOUNT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-317-2006
Mailing Address - Street 1:1709 EVANS ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-5772
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1709 EVANS ST
Practice Address - Street 2:SUITE E
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-5772
Practice Address - Country:US
Practice Address - Phone:252-317-2006
Practice Address - Fax:252-294-1137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-12
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC888465251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health