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General NPI Number Information
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NPI Number | 1407001332
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Entity Type | Organization
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Legal Business Name | WARDS HOLY MANAGEMENT OUTREACH CHURCH
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Dates
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Enumeration Date | 11/19/2008
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Last Update Date | 11/26/2008
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Provider Practice Location Address
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Address Line | 12410 WYOMING ST FL 2
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City | DETROIT
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State | MI
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Zip | 48204
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Country | US
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Telephone | 313-834-4339
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Fax | 313-933-4339
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Provider Business Mailing Address
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Address Line | 25687 FORESTVIEW DR
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City | SOUTHFIELD
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State | MI
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Zip | 48033-2944
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Country | US
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Telephone | 313-655-2975
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Fax | 313-933-4339
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Authorized Official
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Title or Position | CEO
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Name | IDELLA DARLENE WARD
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Credential | NA
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Telephone | 313-655-2975
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | 6501333434
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License Number State | MI
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