Organization
EXCELLENT DICIPLES OF SUCCESS OUTREACH CHURCH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ISSAC E LEWIS (CEO)
(313) 868-1405
Entity
Organization
Contact information
Practice address
25226 INGLESIDE DR, SOUTHFIELD, MI 48033-4837
(313) 868-1405
Mailing address
25226 INGLESIDE DR, SOUTHFIELD, MI 48033-4837
(313) 868-1405
Taxonomy
Speciality
Code
Description
License number
State
251V00000X
Voluntary or Charitable Agency
Primary
—
—
Other
Enumeration date
06/15/2010
Last updated
06/15/2010
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