Provider Demographics
NPI:1306163811
Name:MIND OF CHRIST OUTREACH MINISTRY CHURCH
Entity type:Organization
Organization Name:MIND OF CHRIST OUTREACH MINISTRY CHURCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DARRYL
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-938-9072
Mailing Address - Street 1:2297 W EUCLID ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48206
Mailing Address - Country:US
Mailing Address - Phone:313-938-9072
Mailing Address - Fax:951-735-0181
Practice Address - Street 1:2297 W EUCLID ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48206-2402
Practice Address - Country:US
Practice Address - Phone:313-938-9072
Practice Address - Fax:951-735-0181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-23
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management