Provider Demographics
NPI:1902961915
Name:PREDESTINE LIFE MINISTRIES
Entity Type:Organization
Organization Name:PREDESTINE LIFE MINISTRIES
Other - Org Name:'THE HOUSE OF VALOR'
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR-ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ROCHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE-WELTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-723-9101
Mailing Address - Street 1:PO BOX 182422
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76096-2422
Mailing Address - Country:US
Mailing Address - Phone:817-723-9101
Mailing Address - Fax:
Practice Address - Street 1:2725 SAINT PAUL RD
Practice Address - Street 2:
Practice Address - City:VENUS
Practice Address - State:TX
Practice Address - Zip Code:76084-3516
Practice Address - Country:US
Practice Address - Phone:817-477-0601
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
310400000X, 311ZA0620X, 324500000X
TX320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Not Answered311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Not Answered320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Not Answered324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility