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General NPI Number Information
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NPI Number | 1750104071
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Entity Type | Organization
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Legal Business Name | DETROIT COMMUNITY CARE NETWORK L3C
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Dates
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Enumeration Date | 11/05/2024
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Last Update Date | 09/03/2025
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Provider Practice Location Address
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Address Line | 12850 PLYMOUTH RD
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City | DETROIT
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State | MI
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Zip | 48227-3725
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Country | US
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Telephone | 313-636-1801
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Fax |
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Provider Business Mailing Address
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Address Line | 21549 VIRGINIA ST
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City | SOUTHFIELD
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State | MI
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Zip | 48076-2364
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Country | US
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Telephone | 313-636-1801
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Fax |
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Authorized Official
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Title or Position | MANAGING DIRECTOR
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Name | DAVID UNDERWOOD
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Credential |
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Telephone | 313-636-1801
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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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 | 171400000X
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Taxonomy Name | Health & Wellness Coach
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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