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Organization

FULL GOSPEL

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. ANTOINETTE CUNDIFF (PRESIDENT/PASTOR)
(219) 281-9481
Entity
Organization

Contact information

Practice address
857 PROSPECT ST, VALPARAISO, IN 46385-4552
(219) 281-9481
Mailing address
2701 WILLOWCREEK RD UNIT 1841, PORTAGE, IN 46368-7476
(219) 281-9481

Taxonomy

Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary

Other

Enumeration date
07/03/2024
Last updated
07/03/2024
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