Bloomington Pentecostal Church of God
Organization Active NPI Case Manager/Care Coordinator · Lytle Creek, CA
NPI 1285598243 · NPPES record last updated Dec 15, 2025
Key facts
- NPI
- 1285598243
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Case Manager/Care Coordinator 171M00000X
- Legal business name
- BLOOMINGTON PENTECOSTAL CHURCH OF GOD
- Practice address
- 585 Lytle Creek Rd
Lytle Creek, CA 92358-9758 - Phone
- (909) 900-6011
- NPI assigned
- Dec 15, 2025
- Organization subpart
- No
Authorized official
- Name
- John Deatherage, ORDAINED
- Title
- Pastor
- Phone
- (909) 900-6011
National Provider Directory
Locations
585 Lytle Creek Rd
Lytle Creek, CA 92358
Phone (909) 900-6011
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Manager/Care Coordinator |
171M00000X | Yes |
Addresses
Primary practice location
585 Lytle Creek Rd
Lytle Creek, CA 92358-9758
Mailing address
PO Box 158
Lytle Creek, CA 92358-0158
Phone (909) 900-6011
Other providers in Lytle Creek, CA
All providers in Lytle Creek, CA · Case Manager/Care Coordinator in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 15, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.