City Church 242

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

Legal business name

CITY CHURCH 242

Doing business as

City Church Live In Center

Practice address

743 E Tabor Ave
Fairfield, CA 94533-4046

Phone

(707) 426-2172

NPI assigned

Mar 16, 2016

Organization subpart

Yes

Parent organization

GRACE INTERNATIONAL MINISTRIESAs reported in NPPES

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

Authorized official

Name

Mr. Scott Mulvey

Title

Executive Director / Pastor

Phone

(707) 426-2172

Specialties & licenses 1

Addresses

Other names 1

• City Church Live In Center Doing business as

Locations

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

{
    "created_epoch": "1458086400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1458086400000",
    "number": "1437510542",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "743 E TABOR AVE",
            "city": "FAIRFIELD",
            "state": "CA",
            "postal_code": "945334046",
            "telephone_number": "707-426-2172"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "743 E TABOR AVE",
            "city": "FAIRFIELD",
            "state": "CA",
            "postal_code": "945334046",
            "telephone_number": "707-426-2172"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CITY CHURCH 242",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GRACE INTERNATIONAL MINISTRIES",
        "enumeration_date": "2016-03-16",
        "last_updated": "2016-03-16",
        "status": "A",
        "authorized_official_last_name": "MULVEY",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR / PASTOR",
        "authorized_official_telephone_number": "707-426-2172",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "City Church Live In Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Melissa Marie Chung
• Michelle Gali Church, M.D.
• Cherie Ann Cimino, APCC 18328
• Steven Ciric, M.D.
• Maricela Cisneros
• City of Fairfield
• Citymed Urgent Care
• Sabrina Renee Clark
• Thomas Joseph Clark II
• Claudine Ann Yu DDS Inc

• Substance Abuse Rehabilitation Facility in Fairfield, CA
• Providers in Fairfield, CA by specialty
• Substance Abuse Rehabilitation Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2016; 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.