Provider Demographics
NPI:1619231792
Name:EMMANUEL OUTREACH MINISTRIES, INC
Entity type:Organization
Organization Name:EMMANUEL OUTREACH MINISTRIES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:HILDA
Authorized Official - Middle Name:B
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-574-9983
Mailing Address - Street 1:4761 DRAUGHON RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28312-8480
Mailing Address - Country:US
Mailing Address - Phone:910-484-1701
Mailing Address - Fax:910-484-1701
Practice Address - Street 1:4761 DRAUGHON RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28312-8480
Practice Address - Country:US
Practice Address - Phone:910-484-1701
Practice Address - Fax:910-484-1701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-03
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL-026-060311Z00000X, 311ZA0620X, 347E00000X, 310400000X
NCFCL-026--060347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No347C00000XTransportation ServicesPrivate Vehicle
No347E00000XTransportation ServicesTransportation Broker