Provider Demographics
NPI:1528200458
Name:MAKE THAT CHANGE MINISTRY OUTREACH CHURCH
Entity Type:Organization
Organization Name:MAKE THAT CHANGE MINISTRY OUTREACH CHURCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-549-6059
Mailing Address - Street 1:3044 CORTLAND ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48206-3400
Mailing Address - Country:US
Mailing Address - Phone:313-549-6059
Mailing Address - Fax:313-305-4316
Practice Address - Street 1:11170 HAWTHORNE
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-8540
Practice Address - Country:US
Practice Address - Phone:313-549-6059
Practice Address - Fax:313-305-4316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-24
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable