Provider Demographics
NPI:1780805721
Name:UNIVERSAL LIFE CHURCH INC
Entity type:Organization
Organization Name:UNIVERSAL LIFE CHURCH INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CHIEF CLERGY
Authorized Official - Prefix:DR
Authorized Official - First Name:RODOLFO
Authorized Official - Middle Name:A
Authorized Official - Last Name:NICHOLSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:646-266-4010
Mailing Address - Street 1:PO BOX 0891
Mailing Address - Street 2:KABBALAH VISITING NURSES ASSOCIATION PO
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-0891
Mailing Address - Country:US
Mailing Address - Phone:718-720-0292
Mailing Address - Fax:718-761-5562
Practice Address - Street 1:382 BAY ST
Practice Address - Street 2:SUITE #0102
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-0102
Practice Address - Country:US
Practice Address - Phone:718-720-0292
Practice Address - Fax:718-761-5562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL719468282J00000X
NYA858936282J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282J00000XHospitalsReligious Nonmedical Health Care Institution