Healthcare Provider Details

I. General information

NPI: 1184060121
Provider Name (Legal Business Name): H.O.T.E.P. CHRISTIAN SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2013
Last Update Date: 05/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 N MAIN ST 109
ANN ARBOR MI
48104-1059
US

IV. Provider business mailing address

333 S MAIN ST 202
ANN ARBOR MI
48104-2179
US

V. Phone/Fax

Practice location:
  • Phone: 313-659-8424
  • Fax: 734-780-7749
Mailing address:
  • Phone: 734-789-7749
  • Fax: 734-780-7749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801069413
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number5302410596
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401012466
License Number StateMI

VIII. Authorized Official

Name: DR. URAL HEYWOOD HILL JR.
Title or Position: PRESIDENT/CEO
Credential: PH.D.
Phone: 313-659-8424