MEDICARE: KNOUNA OUTREACH MINISTRY CHURCH

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

General Provider Information

NPI Number	:	1922334374
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KNOUNA OUTREACH MINISTRY CHURCH

Provider Business Mailing Address
First Line	:	8229 LAKE PINE DR
Second Line	:
City	:	COMMERCE TOWNSHIP
State	:	MI
Zip	:	48382-4528
Country	:	US
Telephone Number	:	248-979-2224
Fax Number	:	313-273-4832

Provider Business Practice Location Address
First Line	:	8229 LAKE PINE DR
Second Line	:
City	:	COMMERCE TOWNSHIP
State	:	MI
Zip	:	48382-4528
Country	:	US
Telephone Number	:	248-979-2224
Fax Number	:	313-273-4832

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MRS. MAYSARAH G KNOUNA
Credential	:
Telephone Number	:	248-979-2224

Provider Enumeration Date	:	10/20/2009
Last Update Date	:	10/20/2009

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