Healthcare Provider Details

I. General information

NPI: 1124272844
Provider Name (Legal Business Name): LENDING A HAND OUTREACH MINISTRY CHURCH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2008
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12851 GABLE ST
DETROIT MI
48212-2576
US

IV. Provider business mailing address

12851 GABLE ST
DETROIT MI
48212-2576
US

V. Phone/Fax

Practice location:
  • Phone: 313-732-7215
  • Fax:
Mailing address:
  • Phone: 313-732-7215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number StateMI

VIII. Authorized Official

Name: TYRONE LAMONT JAMES SR.
Title or Position: CEO
Credential:
Phone: 313-732-7215