Healthcare Provider Details

I. General information

NPI: 1609721364
Provider Name (Legal Business Name): WAYNE COUNTY TREASURER PAYROLL-COUNTY OF WAYNE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2026
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6255 INKSTER RD STE 206
GARDEN CITY MI
48135-2538
US

IV. Provider business mailing address

9021 JOSEPH CAMPAU ST
HAMTRAMCK MI
48212-3726
US

V. Phone/Fax

Practice location:
  • Phone: 313-871-1964
  • Fax:
Mailing address:
  • Phone: 313-871-1964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: JAVAR JACKSON
Title or Position: CEO
Credential:
Phone: 313-421-6989