Provider Demographics
NPI:1417355132
Name:TRUE AGAPE ADULT PROGRAM
Entity Type:Organization
Organization Name:TRUE AGAPE ADULT PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:313-974-9953
Mailing Address - Street 1:1500 E STATE FAIR
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48203-1258
Mailing Address - Country:US
Mailing Address - Phone:313-974-9953
Mailing Address - Fax:947-282-8999
Practice Address - Street 1:1500 E STATE FAIR
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48203-1258
Practice Address - Country:US
Practice Address - Phone:313-974-9953
Practice Address - Fax:947-282-8999
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRUE ORACLE OF GOD MINISTRIES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-12-11
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI795232OtherSTATE BUSINESS ID NUMBER