Organization Name: | HOUSE OF PRAYER CHRISTIAN ACADEMY |
NPI Number: | 1700155595 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ANTHONY DEWAYNE PETTIFORD (CEO) |
Mailing Address: | 5501 N Park Dr East Saint Louis |
State: | IL US |
Postal Code: | 622042121 |
Phone Number: | 6182743850 |
Fax Number: | |
NPI Enumeration Date: | 12/22/2011 |
NPI Last Update Date: | 12/22/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |