Organization
LIBERTY TEMPLE OUTREACH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANTHONY COOPER (CEO)
(313) 449-1117
Entity
Organization
Contact information
Practice address
1710 E GRAND BLVD, DETROIT, MI 48211-3146
(313) 449-1117
Mailing address
18951 SUSSEX ST, DETROIT, MI 48235-2841
(313) 449-1117
Taxonomy
Speciality
Code
Description
License number
State
251V00000X
Voluntary or Charitable Agency
Primary
—
—
Other
Enumeration date
01/27/2009
Last updated
01/27/2009
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