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NPI Code Detail

MEDICARE: DETROIT WAYNE COUNTY HEALTH AUTHORITY

MEDICARE: DETROIT WAYNE COUNTY HEALTH AUTHORITY
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
1261QH0100XHealth Service Clinic/Center
23336C0002XClinic Pharmacy
3261Q00000XClinic/Center
4261QM0855XAdolescent and Children Mental Health Clinic/Center
5251S00000XCommunity/Behavioral Health Agency
6251K00000XPublic Health or Welfare Agency251K00000X
7261QP2300XPrimary Care Clinic/Center
8261QC1500XCommunity Health Clinic/Center
9261QF0400XFederally Qualified Health Center (FQHC)

General Provider Information

NPI Number : 1962733089
Entity Type Code : Organization
Provider Name (Legal Business Name) : DETROIT WAYNE COUNTY HEALTH AUTHORITY
Provider Business Mailing Address
First Line : 3031 W GRAND BLVD
Second Line :
City : DETROIT
State : MI
Zip : 48202-3046
Country : US
Telephone Number : 313-824-1000
Fax Number : 313-824-9000
Provider Business Practice Location Address
First Line : 10809 MACK AVE
Second Line :
City : DETROIT
State : MI
Zip : 48214-2119
Country : US
Telephone Number : 313-824-1000
Fax Number : 313-824-9000
Authorized Official
Title or Position : CEO
Name : MRS. LORETTA BUSH
Credential :
Telephone Number : 313-871-3751
Provider Enumeration Date : 01/29/2010
Last Update Date : 12/01/2025

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Directions to “DETROIT WAYNE COUNTY HEALTH AUTHORITY ” Practice Location

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