Healthcare Provider Details

I. General information

NPI: 1275617599
Provider Name (Legal Business Name): COMMUNITY HEALTH AND SOCIAL SERVICES CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5635 W FORT ST
DETROIT MI
48209-3154
US

IV. Provider business mailing address

5635 W FORT ST
DETROIT MI
48209-3154
US

V. Phone/Fax

Practice location:
  • Phone: 313-849-3920
  • Fax: 313-849-0824
Mailing address:
  • Phone: 313-849-3920
  • Fax: 313-849-0824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number5301006207
License Number StateMI

VIII. Authorized Official

Name: FELIX M VALBUENA
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: MD
Phone: 313-849-3920