Provider Demographics
NPI:1427345180
Name:ROPHE' OUTREACH MINISTRIES
Entity type:Organization
Organization Name:ROPHE' OUTREACH MINISTRIES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:WILHEMINA
Authorized Official - Middle Name:JUDKINS
Authorized Official - Last Name:TALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LMBT
Authorized Official - Phone:252-425-8543
Mailing Address - Street 1:501 HAMPTON LN
Mailing Address - Street 2:
Mailing Address - City:YOUNGSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27596-8743
Mailing Address - Country:US
Mailing Address - Phone:919-345-2419
Mailing Address - Fax:
Practice Address - Street 1:201 EAST WAIT ST
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587
Practice Address - Country:US
Practice Address - Phone:919-345-2419
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-01
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1171251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6105166Medicaid