Provider Demographics
NPI:1720238256
Name:UNIVERSAL LIFE CHURCH INC.
Entity type:Organization
Organization Name:UNIVERSAL LIFE CHURCH INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REFLEXOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFIED
Authorized Official - Phone:913-375-2503
Mailing Address - Street 1:PO BOX 172149
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66117-1149
Mailing Address - Country:US
Mailing Address - Phone:913-400-1822
Mailing Address - Fax:913-371-0493
Practice Address - Street 1:1121 QUINDARO BLVD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66104-5331
Practice Address - Country:US
Practice Address - Phone:913-400-1822
Practice Address - Fax:913-371-0493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-20
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCERT.#PS-000289173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173C00000XOther Service ProvidersReflexologistGroup - Single Specialty