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General NPI Number Information
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NPI Number | 1437536802
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Entity Type | Organization
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Legal Business Name | DETROIT RESCUE MISSION MINISTRIES
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Dates
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Enumeration Date | 05/05/2015
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Last Update Date | 05/05/2015
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Provider Practice Location Address
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Address Line | 19211 ANGLIN ST
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City | DETROIT
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State | MI
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Zip | 48234-1460
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Country | US
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Telephone | 313-263-0077
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Fax | 313-305-5007
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Provider Business Mailing Address
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Address Line | 19211 ANGLIN ST
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City | DETROIT
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State | MI
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Zip | 48234-1460
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Country | US
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Telephone | 313-263-0077
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Fax | 313-305-5007
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Authorized Official
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Title or Position | THERAPIST
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Name | MS. LONDON WILSON
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Credential | M.S.W
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Telephone | 313-263-0077
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3245S0500X
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Taxonomy Name | Children's Substance Abuse Rehabilitation Facility
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License Number | 820317
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License Number State | MI
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