MEDICARE: DETROIT CENTRAL CITY COMMUNITY MENTAL HEALTH INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261QD0000X	Dental Clinic/Center
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
3	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1598502817
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DETROIT CENTRAL CITY COMMUNITY MENTAL HEALTH INC.

Provider Business Mailing Address
First Line	:	1240 3RD ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48226-2505
Country	:	US
Telephone Number	:	313-831-3160
Fax Number	:

Provider Business Practice Location Address
First Line	:	1240 3RD ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48226-2505
Country	:	US
Telephone Number	:	313-831-3160
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING SPECIALIST
Name	:	MICHELLE RILEY
Credential	:	RHIT
Telephone Number	:	313-221-8595

Provider Enumeration Date	:	07/12/2024
Last Update Date	:	03/19/2025

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