Provider Demographics
NPI:1396980991
Name:DESTINY OF HOPE OUTREACH MINISTRY CHURCH
Entity type:Organization
Organization Name:DESTINY OF HOPE OUTREACH MINISTRY CHURCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEANA
Authorized Official - Middle Name:LASHAWN
Authorized Official - Last Name:NEELY-ELLISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-459-5699
Mailing Address - Street 1:5564 BRUSH
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202
Mailing Address - Country:US
Mailing Address - Phone:313-459-5699
Mailing Address - Fax:
Practice Address - Street 1:5564 BRUSH ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-3808
Practice Address - Country:US
Practice Address - Phone:313-459-5699
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-10
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable