Provider Demographics
NPI:1053591362
Name:PRAYER WARRIORS ENHANCEMENT TEAM
Entity type:Organization
Organization Name:PRAYER WARRIORS ENHANCEMENT TEAM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROCHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:CDAAC
Authorized Official - Phone:951-956-4026
Mailing Address - Street 1:24490 SUNNYMEAD BLVD STE 107
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-7762
Mailing Address - Country:US
Mailing Address - Phone:951-242-7001
Mailing Address - Fax:951-242-7001
Practice Address - Street 1:24490 SUNNYMEAD BLVD STE 107
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-7762
Practice Address - Country:US
Practice Address - Phone:951-242-7001
Practice Address - Fax:951-242-7001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA330087AN251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable