Organization Name: | EAST GATE CONNECTIONS |
NPI Number: | 1073796447 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DYNEZ ORTEGA BOLDEN (CEO & PRESIDENT) |
Mailing Address: | 4297 Vernon Rd Apt B Harrington |
State: | DE US |
Postal Code: | 199524215 |
Phone Number: | 3026325338 |
Fax Number: | |
NPI Enumeration Date: | 12/08/2007 |
NPI Last Update Date: | 12/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP1600X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Pastoral |
Taxonomy Definition: |