Healthcare Provider Details

I. General information

NPI: 1891907721
Provider Name (Legal Business Name): COMMUNITY SOCIAL SERVICES OF WAYNE COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 06/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9851 HAMILTON AVE
DETROIT MI
48202-1424
US

IV. Provider business mailing address

9851 HAMILTON AVE
DETROIT MI
48202-1424
US

V. Phone/Fax

Practice location:
  • Phone: 313-883-2100
  • Fax: 313-883-3957
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 NumberSA0820021
License Number StateMI

VIII. Authorized Official

Name: MR. PATRICK J HERON
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 313-883-2339