Healthcare Provider Details

I. General information

NPI: 1932579265
Provider Name (Legal Business Name): DETROIT RECOVERY PROJECT, INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2015
Last Update Date: 04/29/2022
Certification Date: 04/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1165 W GRAND BLVD
DETROIT MI
48208-2338
US

IV. Provider business mailing address

1121 E MCNICHOLS RD
DETROIT MI
48203-2857
US

V. Phone/Fax

Practice location:
  • Phone: 313-324-8900
  • Fax: 313-324-8701
Mailing address:
  • Phone: 313-365-3113
  • Fax: 313-365-3098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberSA0823227
License Number StateMI

VIII. Authorized Official

Name: KANZONI NEUMANN ASABIGI
Title or Position: VP
Credential: MD, PHD
Phone: 313-324-8900