MEDICARE: ISLAMIC CENTER OF DETROIT

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251B00000X	Case Management Agency
2	251S00000X	Community/Behavioral Health Agency
3	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
4	261QM0850X	Adult Mental Health Clinic/Center
5	261QM0855X	Adolescent and Children Mental Health Clinic/Center
6	261QM1000X	Migrant Health Clinic/Center
7	332U00000X	Home Delivered Meals
8	251K00000X	Public Health or Welfare Agency

General Provider Information

NPI Number	:	1578303095
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ISLAMIC CENTER OF DETROIT

Provider Business Mailing Address
First Line	:	14350 TIREMAN ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48228-6100
Country	:	US
Telephone Number	:	313-584-4143
Fax Number	:

Provider Business Practice Location Address
First Line	:	14350 TIREMAN ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48228-6100
Country	:	US
Telephone Number	:	313-584-4143
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. SUFIAN NABHAN
Credential	:
Telephone Number	:	313-584-4143

Provider Enumeration Date	:	05/31/2024
Last Update Date	:	01/24/2025

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