Provider Demographics
NPI:1124226428
Name:THE DR. ALBERT B. CLEAGE, SR. MEMORIAL HEALTH CENTER
Entity Type:Organization
Organization Name:THE DR. ALBERT B. CLEAGE, SR. MEMORIAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-874-1300
Mailing Address - Street 1:700 SEWARD ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-2427
Mailing Address - Country:US
Mailing Address - Phone:313-874-1300
Mailing Address - Fax:313-874-3140
Practice Address - Street 1:700 SEWARD ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2427
Practice Address - Country:US
Practice Address - Phone:313-874-1300
Practice Address - Fax:313-874-3140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-07
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI793834261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care