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General NPI Number Information
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NPI Number | 1720104433
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Entity Type | Organization
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Legal Business Name | SOUTHERN CHRISTIAN LEADERSHIP CONFERENCE
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5050 JOY RD
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City | DETROIT
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State | MI
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Zip | 48204-2263
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Country | US
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Telephone | 313-894-3950
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Fax | 313-894-1729
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Provider Business Mailing Address
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Address Line | 8500 14TH ST
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City | DETROIT
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State | MI
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Zip | 48206-2425
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Country | US
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Telephone | 313-894-3950
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Fax | 313-894-1729
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CLAUD R YOUNG
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Credential | DO
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Telephone | 313-894-3950
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 0Q24522
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License Number State | MI
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