Healthcare Provider Details

I. General information

NPI: 1619112554
Provider Name (Legal Business Name): EXCEPTIONAL DELIVERENCE MINISTRIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2008
Last Update Date: 12/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19774 FORRER ST
DETROIT MI
48235-2307
US

IV. Provider business mailing address

19774 FORRER ST
DETROIT MI
48235-2307
US

V. Phone/Fax

Practice location:
  • Phone: 313-633-6712
  • Fax: 313-397-8671
Mailing address:
  • Phone: 313-633-6712
  • Fax: 313-397-8671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. DONNA MICHELE KNIGHT
Title or Position: DIRECTOR
Credential:
Phone: 313-633-6712