Healthcare Provider Details

I. General information

NPI: 1003325440
Provider Name (Legal Business Name): DETROIT HEALTH CARE FOR THE HOMELESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2017
Last Update Date: 07/18/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15400 W MCNICHOLS RD
DETROIT MI
48235-3724
US

IV. Provider business mailing address

100 RIVER PLACE DR STE 450
DETROIT MI
48207-5402
US

V. Phone/Fax

Practice location:
  • Phone: 313-416-6262
  • Fax: 313-221-8217
Mailing address:
  • Phone: 313-416-6220
  • Fax: 313-221-8217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: NINA ABUBAKARI
Title or Position: CEO
Credential:
Phone: 313-416-6220