Provider Demographics
NPI:1922251545
Name:GRACIOUS OUTREACH MINISTRIES
Entity Type:Organization
Organization Name:GRACIOUS OUTREACH MINISTRIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN/ CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:TANISHA
Authorized Official - Middle Name:C
Authorized Official - Last Name:BURTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-739-3352
Mailing Address - Street 1:PO BOX 32797
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48232-0797
Mailing Address - Country:US
Mailing Address - Phone:313-739-3352
Mailing Address - Fax:313-887-4081
Practice Address - Street 1:17336 W 12 MILE RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-2113
Practice Address - Country:US
Practice Address - Phone:313-739-3352
Practice Address - Fax:313-887-4081
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPIRITLOVE MINISTRIES INTERNATIONAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-28
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable