MEDICARE: ADAM'S APPLE OUTREACH MINISTRIES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251V00000X	Voluntary or Charitable Agency		MI

General Provider Information

NPI Number	:	1639324700
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADAM'S APPLE OUTREACH MINISTRIES

Provider Business Mailing Address
First Line	:	26222 PRINCETON ST
Second Line	:
City	:	INKSTER
State	:	MI
Zip	:	48141-2493
Country	:	US
Telephone Number	:	313-491-6934
Fax Number	:

Provider Business Practice Location Address
First Line	:	4074 TYLER ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48238-5207
Country	:	US
Telephone Number	:	313-491-6934
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MRS. BERNIECE JAMES
Credential	:
Telephone Number	:	313-491-6934

Provider Enumeration Date	:	11/17/2008
Last Update Date	:	11/17/2008

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Directions to “ADAM'S APPLE OUTREACH MINISTRIES ” Practice Location

Language	Start Address	Practice Location

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