Provider Demographics
NPI:1316206931
Name:G.O.D.S PLAN OF REHABILITATION
Entity type:Organization
Organization Name:G.O.D.S PLAN OF REHABILITATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/PASTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:R
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:SR
Authorized Official - Credentials:COUNSELOR
Authorized Official - Phone:901-794-5682
Mailing Address - Street 1:4572 COGNAC CV
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38141-7803
Mailing Address - Country:US
Mailing Address - Phone:901-794-5682
Mailing Address - Fax:901-794-3539
Practice Address - Street 1:4572 COGNAC CV
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38141-7803
Practice Address - Country:US
Practice Address - Phone:901-794-5682
Practice Address - Fax:901-794-3539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-16
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty