Provider Demographics
NPI:1437536802
Name:DETROIT RESCUE MISSION MINISTRIES
Entity Type:Organization
Organization Name:DETROIT RESCUE MISSION MINISTRIES
Other - Org Name:CHRISTIAN GUIDANCE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:LONDON
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:313-263-0077
Mailing Address - Street 1:19211 ANGLIN ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48234-1460
Mailing Address - Country:US
Mailing Address - Phone:313-263-0077
Mailing Address - Fax:313-305-5007
Practice Address - Street 1:19211 ANGLIN ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48234-1460
Practice Address - Country:US
Practice Address - Phone:313-263-0077
Practice Address - Fax:313-305-5007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-05
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI8203173245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children