Provider Demographics
NPI:1972836443
Name:DIGNITY OUTREACH MINISTRY CHURCH
Entity type:Organization
Organization Name:DIGNITY OUTREACH MINISTRY CHURCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSANNE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BASCHAROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-881-0010
Mailing Address - Street 1:2260 ROSEANN DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314-2724
Mailing Address - Country:US
Mailing Address - Phone:248-881-0010
Mailing Address - Fax:586-731-6848
Practice Address - Street 1:31964 STAMAN CT
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-1866
Practice Address - Country:US
Practice Address - Phone:248-881-0010
Practice Address - Fax:586-731-6848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-15
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable