International Pentecostal Assy. Ecum. (Ipae)

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

DCN:005115 Issued in IL

Legal business name

INTERNATIONAL PENTECOSTAL ASSY. ECUM. (IPAE)

Practice address

1311 E Steger Rd
Steger, IL 60475-6017

Phone

(855) 358-5353

Fax

(708) 758-1845

NPI assigned

Dec 27, 2011

Last updated

Dec 27, 2011By the provider in NPPES

Organization subpart

Yes

Parent organization

BROTHERS KEEPER COMMUNITY RESOURCE CENTER (CRC)As reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

William McCoy Sr.

Title

Ceo

Phone

(708) 758-1840

Specialties & licenses 2

Addresses

Other names 1

• Brothers Keeper Community Resource Center (CrC) Other name

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1324944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1324944000000",
    "number": "1407125156",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "283 E 14TH ST",
            "city": "CHICAGO HEIGHTS",
            "state": "IL",
            "postal_code": "604112837",
            "telephone_number": "708-758-1840",
            "fax_number": "708-758-1845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1311 E STEGER RD",
            "city": "STEGER",
            "state": "IL",
            "postal_code": "604756017",
            "telephone_number": "855-358-5353",
            "fax_number": "708-758-1845"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERNATIONAL PENTECOSTAL ASSY. ECUM. (IPAE)",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BROTHERS KEEPER COMMUNITY RESOURCE CENTER (CRC)",
        "enumeration_date": "2011-12-27",
        "last_updated": "2011-12-27",
        "status": "A",
        "authorized_official_last_name": "MCCOY",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "708-758-1840",
        "authorized_official_name_suffix": "Sr."
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "IL",
            "license": "DCN:005115",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brothers Keeper Community Resource Center (CrC)",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Community/Behavioral Health Agency in Steger, IL
• Providers in Steger, IL by specialty
• Community/Behavioral Health Agency in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.