Provider Demographics
NPI:1912314436
Name:CHRIST TABERNACLE MINISTRIES OF EXCELLENCE INC.
Entity Type:Organization
Organization Name:CHRIST TABERNACLE MINISTRIES OF EXCELLENCE INC.
Other - Org Name:STEP OF FAITH COMPREHENSIVE HEALTH AND WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDNA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:LACKEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN MBA PHD
Authorized Official - Phone:513-771-3412
Mailing Address - Street 1:11260 CHESTER RD STE 240
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45246-4050
Mailing Address - Country:US
Mailing Address - Phone:513-771-3412
Mailing Address - Fax:
Practice Address - Street 1:11260 CHESTER RD STE 240
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246-4050
Practice Address - Country:US
Practice Address - Phone:513-771-3412
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-16
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 101YP1600X, 163WA2000X, 163WD0400X, 174H00000X
OH261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty
No163WA2000XNursing Service ProvidersRegistered NurseAdministratorGroup - Multi-Specialty
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes EducatorGroup - Multi-Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty