Healthcare Provider Details

I. General information

NPI: 1417178609
Provider Name (Legal Business Name): COMMUNITY SOCIAL SERVICES OF WAYNE COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 06/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19855 WEST OUTER DR SUITE 207-E
DEARBORN MI
48124-2028
US

IV. Provider business mailing address

9851 HAMILTON AVE
DETROIT MI
48202-1424
US

V. Phone/Fax

Practice location:
  • Phone: 313-792-9286
  • Fax: 313-792-0444
Mailing address:
  • Phone: 313-883-2100
  • Fax: 313-883-3957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number820537
License Number StateMI

VIII. Authorized Official

Name: MR. PATRICK J HERON
Title or Position: PRESIDENT & CEO
Credential:
Phone: 313-883-2339