Provider Demographics
NPI:1811280837
Name:MIGHTY WARRIORS CHRISTIAN FELLOWSHIP
Entity type:Organization
Organization Name:MIGHTY WARRIORS CHRISTIAN FELLOWSHIP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:HOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:TMD
Authorized Official - Phone:919-273-3587
Mailing Address - Street 1:904 DEVEREAUX ST
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27530
Mailing Address - Country:US
Mailing Address - Phone:919-648-3107
Mailing Address - Fax:919-710-8245
Practice Address - Street 1:157 OLD GRANTHAM RD
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-5617
Practice Address - Country:US
Practice Address - Phone:919-273-3587
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-24
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCATYPICAL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty