Provider Demographics
NPI:1649636119
Name:HOLY TEMPLE CHURCH ADULT DAY CARE CENTER
Entity type:Organization
Organization Name:HOLY TEMPLE CHURCH ADULT DAY CARE CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PASTOR/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-465-0655
Mailing Address - Street 1:8590 ESPER ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48204-3183
Mailing Address - Country:US
Mailing Address - Phone:313-465-0655
Mailing Address - Fax:
Practice Address - Street 1:19346 MIDDLESEX AVE
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-4439
Practice Address - Country:US
Practice Address - Phone:313-465-0655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOLY TEMPLE CHURCH OF THE LIVING GOD IN JESUS W.C.,INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-01-13
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral Health
No385H00000XRespite Care FacilityRespite Care