MEDICARE: HOLY TEMPLE CHURCH ADULT DAY CARE CENTER

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251S00000X	Community/Behavioral Health Agency
2	385H00000X	Respite Care
3	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1649636119
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOLY TEMPLE CHURCH ADULT DAY CARE CENTER

Provider Business Mailing Address
First Line	:	8590 ESPER ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48204-3183
Country	:	US
Telephone Number	:	313-465-0655
Fax Number	:

Provider Business Practice Location Address
First Line	:	19346 MIDDLESEX AVE
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48076-4439
Country	:	US
Telephone Number	:	313-465-0655
Fax Number	:

Authorized Official
Title or Position	:	PASTOR/CEO
Name	:	MRS. PAMELA DIXON
Credential	:
Telephone Number	:	313-465-0655

Provider Enumeration Date	:	01/13/2016
Last Update Date	:	01/13/2016

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