Provider Demographics
NPI:1447007448
Name:IN THE IMAGE OF CHRIST INC
Entity type:Organization
Organization Name:IN THE IMAGE OF CHRIST INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:HERTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-359-5549
Mailing Address - Street 1:3090 AVENUE G
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34947-5912
Mailing Address - Country:US
Mailing Address - Phone:772-461-7788
Mailing Address - Fax:
Practice Address - Street 1:3090 AVENUE G
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34947-5912
Practice Address - Country:US
Practice Address - Phone:772-461-7788
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-06
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty