# DESTINY LIFE CENTER COG

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** GENERAL ASSEMBLY OF THE CHURCH OF GOD
- **Other names:** Victory House for women, Victory House for women
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1679044960
- **Legal business name:** GENERAL ASSEMBLY OF THE CHURCH OF GOD
- **Authorized official:** PATRICIA JIMERSON (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (260) 557-6183

## Contact information

- **Practice address:** 518 E JEFFERSON BLVD, FORT WAYNE, IN 46802-3204
- **Practice address phone:** (260) 557-6183
- **Mailing address:** 518 E JEFFERSON BLVD, FORT WAYNE, IN 46802-3204
- **Mailing address phone:** (260) 557-6183

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 174200000X | Meals Provider | — | NULL | — |
| 177F00000X | Lodging Provider | — | NULL | — |
| 251S00000X | Community/Behavioral Health Agency | — | NULL | — |
| 253Z00000X | In Home Supportive Care Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 12/11/2018
- **Last updated:** 12/11/2018