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NPI Code Detail

MEDICARE: COMMUNITY HEALTH AND SOCIAL SERVICES CENTER, INC

MEDICARE: COMMUNITY HEALTH AND SOCIAL SERVICES CENTER, INC
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
1261QF0400XFederally Qualified Health Center (FQHC)

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1080Q246390OTHERMIBC/BS OF MICHIGAN

General Provider Information

NPI Number : 1982694196
Entity Type Code : Organization
Provider Name (Legal Business Name) : COMMUNITY HEALTH AND SOCIAL SERVICES CENTER, INC
Provider Business Mailing Address
First Line : 5635 W FORT ST
Second Line :
City : DETROIT
State : MI
Zip : 48209-3154
Country : US
Telephone Number : 313-849-3920
Fax Number : 313-849-0824
Provider Business Practice Location Address
First Line : 5635 W FORT ST
Second Line :
City : DETROIT
State : MI
Zip : 48209-3154
Country : US
Telephone Number : 313-849-3920
Fax Number : 313-849-0824
Authorized Official
Title or Position : CEO
Name : FELIX MARIO VALBUENA JR.
Credential : MD
Telephone Number : 313-849-3920
Provider Enumeration Date : 10/27/2005
Last Update Date : 11/15/2022

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1083820203 — MR. ANTONIO LOPEZ MD
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Directions to “COMMUNITY HEALTH AND SOCIAL SERVICES CENTER, INC ” Practice Location

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