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General NPI Number Information
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NPI Number | 1508718248
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Entity Type | Organization
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Legal Business Name | DETROIT WAYNE COUNTY HEALTH AUTHORITY
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Dates
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Enumeration Date | 02/13/2026
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Last Update Date | 02/13/2026
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Provider Practice Location Address
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Address Line | 10809 MACK AVE
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City | DETROIT
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State | MI
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Zip | 48214-2119
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Country | US
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Telephone | 313-824-1000
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Fax | 313-824-9000
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Provider Business Mailing Address
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Address Line | 10809 MACK AVE
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City | DETROIT
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State | MI
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Zip | 48214-2119
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Country | US
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Telephone | 313-824-1000
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Fax | 313-824-9000
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Authorized Official
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Title or Position | CEO
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Name | LORETTA VIOLET BUSH
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Credential |
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Telephone | 313-824-1000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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