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General NPI Number Information
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NPI Number | 1114520806
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Entity Type | Organization
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Legal Business Name | S.A.Y DETROIT HEALTH CLINIC
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Dates
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Enumeration Date | 11/17/2020
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Last Update Date | 11/17/2020
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Provider Practice Location Address
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Address Line | 211 GLENDALE ST STE 1000
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City | HIGHLAND PARK
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State | MI
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Zip | 48203-3231
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Country | US
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Telephone | 313-758-6100
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Fax |
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Provider Business Mailing Address
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Address Line | 211 GLENDALE ST STE 1000
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City | HIGHLAND PARK
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State | MI
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Zip | 48203-3231
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Country | US
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Telephone | 313-758-6100
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | TAWANA NETTLES-ROBINSON
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Credential |
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Telephone | 313-758-6100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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