Healthcare Provider Details

I. General information

NPI: 1225337314
Provider Name (Legal Business Name): URBAN HEALTH OUTREACH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2011
Last Update Date: 08/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3031 W GRAND BLVD SUITE 675
DETROIT MI
48202-3046
US

IV. Provider business mailing address

3031 W GRAND BLVD SUITE 675
DETROIT MI
48202-3046
US

V. Phone/Fax

Practice location:
  • Phone: 313-664-0100
  • Fax: 313-664-0111
Mailing address:
  • Phone: 313-664-0100
  • Fax: 313-664-0111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. PAULA S GREEN-SMITH
Title or Position: PRESIDENT/CEO
Credential: M.A.
Phone: 313-664-0100