Healthcare Provider Details

I. General information

NPI: 1184935488
Provider Name (Legal Business Name): DOWNRIVER COMMUNITY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2010
Last Update Date: 03/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 MILITARY ST
PORT HURON MI
48060-5416
US

IV. Provider business mailing address

555 SAINT CLAIR RIVER DR
ALGONAC MI
48001-1802
US

V. Phone/Fax

Practice location:
  • Phone: 810-488-8000
  • Fax: 810-488-8005
Mailing address:
  • Phone: 810-794-4982
  • Fax: 810-794-4407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL J BARANOWSKI
Title or Position: CEO
Credential:
Phone: 586-749-5197