Healthcare Provider Details

I. General information

NPI: 1396658092
Provider Name (Legal Business Name): DETROIT POWER DETROIT COMMUNITY OUTREACH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19403 W CHICAGO ST
DETROIT MI
48228-1741
US

IV. Provider business mailing address

19403 W CHICAGO ST
DETROIT MI
48228-1741
US

V. Phone/Fax

Practice location:
  • Phone: 313-349-5880
  • Fax:
Mailing address:
  • Phone: 313-349-5880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER VAN PABLO
Title or Position: CAREGIVER DIRECTOR
Credential:
Phone: 313-349-5880