Provider Demographics
NPI:1386186534
Name:YOUR DESTINY MINISTRY INC
Entity Type:Organization
Organization Name:YOUR DESTINY MINISTRY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PASTOR/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:SPICER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:1231-683-6592
Mailing Address - Street 1:8226 PEMBROKE AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48221-1160
Mailing Address - Country:US
Mailing Address - Phone:123-168-3659
Mailing Address - Fax:
Practice Address - Street 1:14819 PLYMOUTH RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48227-2443
Practice Address - Country:US
Practice Address - Phone:123-168-3659
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YOUR DESTINY MINISTRY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-11-04
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI101YP1600X, 253Z00000X, 343900000X, 347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Single Specialty
No253Z00000XAgenciesIn Home Supportive Care
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate VehicleGroup - Single Specialty