Provider Demographics
NPI:1104303841
Name:ADVENT GROUP MINISTRIES
Entity type:Organization
Organization Name:ADVENT GROUP MINISTRIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:FAITH
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-256-4643
Mailing Address - Street 1:90 GREAT OAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95119-1314
Mailing Address - Country:US
Mailing Address - Phone:408-281-0708
Mailing Address - Fax:408-281-2658
Practice Address - Street 1:1325 BRYANT AVE
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-4580
Practice Address - Country:US
Practice Address - Phone:408-281-0708
Practice Address - Fax:408-281-2658
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVENT GROUP MINISTRIES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-07-25
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========Medicaid