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General NPI Number Information
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NPI Number | 1306257852
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Entity Type | Organization
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Legal Business Name | VICTORY UNTO SALVATION FAITH MINISTRIES DBA THE PHILIP HOUSE MISSION
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Dates
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Enumeration Date | 05/17/2014
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Last Update Date | 01/26/2015
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Provider Practice Location Address
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Address Line | 18066 JAMES COUZENS FWY 2305 PASADENA
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City | DETROIT
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State | MI
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Zip | 48235-2646
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Country | US
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Telephone | 313-828-2202
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Fax |
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Provider Business Mailing Address
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Address Line | 18066 JAMES COUZENS FWY
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City | DETROIT
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State | MI
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Zip | 48235-2646
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Country | US
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Telephone | 313-828-2202
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. KARRIE A BROWN
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Credential |
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Telephone | 313-828-2202
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | SA0823215
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | SA0823215
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License Number State | MI
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