Provider Demographics
NPI:1306603816
Name:LORD OF HEAVEN'S ARMIES LLC
Entity type:Organization
Organization Name:LORD OF HEAVEN'S ARMIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PRESTON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:317-500-4362
Mailing Address - Street 1:9304 TOWER BRIDGE RD APT B
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-5435
Mailing Address - Country:US
Mailing Address - Phone:317-500-4362
Mailing Address - Fax:
Practice Address - Street 1:3549 BOULEVARD PL
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46208-4403
Practice Address - Country:US
Practice Address - Phone:317-500-4362
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-01
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty