Provider Demographics
NPI:1336964139
Name:MANNA HOUSE MINISTRIES
Entity type:Organization
Organization Name:MANNA HOUSE MINISTRIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPCA-MHSP, CADC
Authorized Official - Phone:931-752-7075
Mailing Address - Street 1:PO BOX 962
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38556-0962
Mailing Address - Country:US
Mailing Address - Phone:931-752-7075
Mailing Address - Fax:
Practice Address - Street 1:326 WHITE OAK ST
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:TN
Practice Address - Zip Code:38556-4206
Practice Address - Country:US
Practice Address - Phone:931-752-7075
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility