Provider Demographics
NPI:1881426898
Name:GOD-S-LAND
Entity type:Organization
Organization Name:GOD-S-LAND
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:RAEANNA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:CHREST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-870-7949
Mailing Address - Street 1:4570 AVERY LN SE STE C5114
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-5608
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:215 LEGION WAY SW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-1219
Practice Address - Country:US
Practice Address - Phone:360-870-7949
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-17
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase ManagementGroup - Single Specialty