Provider Demographics
NPI:1073750261
Name:PROMISED LAND MINISTRIES
Entity Type:Organization
Organization Name:PROMISED LAND MINISTRIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:TILLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-685-6643
Mailing Address - Street 1:4545 HEREFORD ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48224-1404
Mailing Address - Country:US
Mailing Address - Phone:313-685-6643
Mailing Address - Fax:313-417-5652
Practice Address - Street 1:4545 HEREFORD ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48224-1404
Practice Address - Country:US
Practice Address - Phone:313-685-6643
Practice Address - Fax:313-417-5652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-09
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable