Provider Demographics
NPI:1407000565
Name:INTERNATIONAL DELIVERANCE CENTER CDC
Entity Type:Organization
Organization Name:INTERNATIONAL DELIVERANCE CENTER CDC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR PASTOR/FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:MILTON
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:WOODS
Authorized Official - Suffix:
Authorized Official - Credentials:DD
Authorized Official - Phone:313-921-3100
Mailing Address - Street 1:7200 HARPER AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48213-2404
Mailing Address - Country:US
Mailing Address - Phone:313-921-3100
Mailing Address - Fax:313-921-7574
Practice Address - Street 1:7200 HARPER AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48213-2404
Practice Address - Country:US
Practice Address - Phone:313-921-3100
Practice Address - Fax:313-921-7574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-14
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service