=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437448818
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHRISTIAN GUIDANCE CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/06/2011
-----------------------------------------------------
Last Update Date | 04/06/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 91 GLENDALE ST
-----------------------------------------------------
City | HIGHLAND PARK
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48203-3274
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-263-0077
-----------------------------------------------------
Fax | 313-883-0422
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 91 GLENDALE ST
-----------------------------------------------------
City | HIGHLAND PARK
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48203-3274
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-263-0077
-----------------------------------------------------
Fax | 313-883-0422
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADDICTIONS COUNSELOR
-----------------------------------------------------
Name | MR. MINOR STEVEN ALEXANDER
-----------------------------------------------------
Credential | B.S.
-----------------------------------------------------
Telephone | 313-236-0077
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 324500000X
-----------------------------------------------------
Taxonomy Name | Substance Abuse Rehabilitation Facility
-----------------------------------------------------
License Number | 820317
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------