Healthcare Provider Details

I. General information

NPI: 1104997121
Provider Name (Legal Business Name): DETROIT AREA AGENCY ON AGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 02/07/2023
Certification Date: 12/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1333 BREWERY PARK BLVD STE 200
DETROIT MI
48207-4544
US

IV. Provider business mailing address

1333 BREWERY PARK BLVD STE 200
DETROIT MI
48207-4544
US

V. Phone/Fax

Practice location:
  • Phone: 313-446-4444
  • Fax: 313-446-4445
Mailing address:
  • Phone: 313-446-4444
  • Fax: 313-446-4445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. RONALD TAYLOR
Title or Position: PRESIDENT & CEO
Credential:
Phone: 313-446-4444