Provider Demographics
NPI:1033446091
Name:SUNRISE HAVEN MINISTRY CHURCH 1
Entity Type:Organization
Organization Name:SUNRISE HAVEN MINISTRY CHURCH 1
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:M
Authorized Official - Last Name:SAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-784-8077
Mailing Address - Street 1:56 MIDLAND ST
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48203-2684
Mailing Address - Country:US
Mailing Address - Phone:313-784-8077
Mailing Address - Fax:
Practice Address - Street 1:56 MIDLAND ST
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:MI
Practice Address - Zip Code:48203-2684
Practice Address - Country:US
Practice Address - Phone:313-784-8077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-12
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable