MEDICARE: COMMUNITY HEALTH AWARENESS GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)
2	251S00000X	Community/Behavioral Health Agency	6801071630	MI

General Provider Information

NPI Number	:	1417384223
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY HEALTH AWARENESS GROUP

Provider Business Mailing Address
First Line	:	1300 W FORT ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48226-3007
Country	:	US
Telephone Number	:	313-963-3434
Fax Number	:	313-963-1832

Provider Business Practice Location Address
First Line	:	1300 W FORT ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48226-3007
Country	:	US
Telephone Number	:	313-963-3434
Fax Number	:	313-963-1832

Authorized Official
Title or Position	:	DIRECTOR OF CLINICAL SERVICES
Name	:	MS. CHRISTINA FLUKER
Credential	:	LMSW
Telephone Number	:	313-963-3434

Provider Enumeration Date	:	10/11/2013
Last Update Date	:	11/21/2014

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