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General NPI Number Information
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NPI Number | 1598502817
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Entity Type | Organization
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Legal Business Name | DETROIT CENTRAL CITY COMMUNITY MENTAL HEALTH INC.
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Dates
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Enumeration Date | 07/12/2024
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Last Update Date | 03/19/2025
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Provider Practice Location Address
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Address Line | 1240 3RD ST
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City | DETROIT
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State | MI
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Zip | 48226-2505
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Country | US
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Telephone | 313-831-3160
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Fax |
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Provider Business Mailing Address
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Address Line | 1240 3RD ST
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City | DETROIT
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State | MI
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Zip | 48226-2505
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Country | US
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Telephone | 313-831-3160
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | MICHELLE RILEY
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Credential | RHIT
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Telephone | 313-221-8595
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #3
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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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