Healthcare Provider Details

I. General information

NPI: 1306793476
Provider Name (Legal Business Name): JESUS WORSHIP MINISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2026
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9065 BEECH DALY RD
REDFORD MI
48239-1705
US

IV. Provider business mailing address

9065 BEECH DALY RD
REDFORD MI
48239-1705
US

V. Phone/Fax

Practice location:
  • Phone: 832-306-5767
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code282J00000X
TaxonomyReligious Nonmedical Health Care Institution
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code374K00000X
TaxonomyReligious Nonmedical Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JOHN UGOCHUKWU
Title or Position: REVEREND
Credential:
Phone: 832-306-5767