Healthcare Provider Details

I. General information

NPI: 1063545556
Provider Name (Legal Business Name): DETROIT RESCUE MISSION MINISTRIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3840 FAIRVIEW ST
DETROIT MI
48214-1608
US

IV. Provider business mailing address

150 STIMSON ST
DETROIT MI
48201-2410
US

V. Phone/Fax

Practice location:
  • Phone: 313-331-8990
  • Fax: 313-331-6375
Mailing address:
  • Phone: 313-993-4700
  • Fax: 313-831-2299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number821050
License Number StateMI

VIII. Authorized Official

Name: DR. CHAD AUDI
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 313-993-4700