Healthcare Provider Details

I. General information

NPI: 1003119843
Provider Name (Legal Business Name): NATIONAL CHAPLAIN SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2010
Last Update Date: 12/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

457 N SYBALD ST
WESTLAND MI
48185-8638
US

IV. Provider business mailing address

457 N SYBALD ST
WESTLAND MI
48185-8638
US

V. Phone/Fax

Practice location:
  • Phone: 313-838-8310
  • Fax: 734-326-5922
Mailing address:
  • Phone: 313-838-8310
  • Fax: 734-326-5922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: DR. BENNIE LEE OLIPHANT SR.
Title or Position: CHAPLAIN
Credential: DMIN
Phone: 313-938-8310