Provider Demographics
NPI:1699318766
Name:NEW SALEM MISSIONARY BAPTIST CHURCH
Entity type:Organization
Organization Name:NEW SALEM MISSIONARY BAPTIST CHURCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHASMA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-522-2951
Mailing Address - Street 1:2507 BRYANT AVE N
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55411-2116
Mailing Address - Country:US
Mailing Address - Phone:612-522-2951
Mailing Address - Fax:612-529-9416
Practice Address - Street 1:2507 BRYANT AVE N
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55411-2116
Practice Address - Country:US
Practice Address - Phone:612-522-2951
Practice Address - Fax:612-529-9416
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEW SALEM MISSIONARY BAPTIST CHURCH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-10-22
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children