=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235378811
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INSPIRING TO ACHIEVE MINISTRIES CHURCH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/05/2009
-----------------------------------------------------
Last Update Date | 02/05/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3906 24TH ST
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48208-2418
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-656-9206
-----------------------------------------------------
Fax | 313-272-2678
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17300 SAINT MARYS ST
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48235-3532
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-656-9206
-----------------------------------------------------
Fax | 313-272-2678
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MRS. CYNTHIA REEVES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 313-656-9206
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251V00000X
-----------------------------------------------------
Taxonomy Name | Voluntary or Charitable Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------