Provider Demographics
NPI:1386117729
Name:SPIRITUAL RESTORATION MINISTRY LLC.
Entity type:Organization
Organization Name:SPIRITUAL RESTORATION MINISTRY LLC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DEPUTY DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CORDLES
Authorized Official - Middle Name:WALKER
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:ETC
Authorized Official - Phone:907-992-2320
Mailing Address - Street 1:1601 E 84TH AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-3160
Mailing Address - Country:US
Mailing Address - Phone:907-992-2320
Mailing Address - Fax:907-344-1134
Practice Address - Street 1:1601 E 84TH AVE STE 203
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-3160
Practice Address - Country:US
Practice Address - Phone:907-887-6584
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-08
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Single Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
No251B00000XAgenciesCase ManagementGroup - Single Specialty
No261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery CareGroup - Single Specialty