Provider Demographics
NPI:1952418279
Name:EPHESIANS LIFE MINISTRIES, INC.
Entity Type:Organization
Organization Name:EPHESIANS LIFE MINISTRIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BRENA
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:301-439-7191
Mailing Address - Street 1:1620 ELTON RD
Mailing Address - Street 2:SUITE #204
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20903-1740
Mailing Address - Country:US
Mailing Address - Phone:301-439-7191
Mailing Address - Fax:301-439-1169
Practice Address - Street 1:1620 ELTON RD
Practice Address - Street 2:SUITE #204
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20903-1740
Practice Address - Country:US
Practice Address - Phone:301-439-7191
Practice Address - Fax:301-439-1169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2011-02-08
Deactivation Date:2006-08-24
Deactivation Code:
Reactivation Date:2006-09-11
Provider Licenses
StateLicense IDTaxonomies
MD02951678251S00000X, 251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251V00000XAgenciesVoluntary or Charitable