Healthcare Provider Details

I. General information

NPI: 1891091492
Provider Name (Legal Business Name): DOWNRIVER COMMUNITY SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2011
Last Update Date: 03/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 SAINT CLAIR RIVER DR
ALGONAC MI
48001-1802
US

IV. Provider business mailing address

555 SAINT CLAIR RIVER DR
ALGONAC MI
48001-1802
US

V. Phone/Fax

Practice location:
  • Phone: 586-270-8055
  • Fax: 810-857-9021
Mailing address:
  • Phone: 810-857-9025
  • Fax: 810-857-9021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301009466
License Number StateMI

VIII. Authorized Official

Name: CYNTHIA ROUSH
Title or Position: CEO
Credential:
Phone: 586-270-8055