Provider Demographics
NPI:1215200399
Name:DETROIT COMMUNITY HEALTH CONNECTION, INC.
Entity Type:Organization
Organization Name:DETROIT COMMUNITY HEALTH CONNECTION, INC.
Other - Org Name:DAAA/DETROIT COMMUNITY HEALTH CONNECTION, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SRVP/CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MAHIPAL
Authorized Official - Middle Name:RAO
Authorized Official - Last Name:KAKARALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-821-2591
Mailing Address - Street 1:13901 E JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48215-2720
Mailing Address - Country:US
Mailing Address - Phone:313-821-2591
Mailing Address - Fax:313-822-4202
Practice Address - Street 1:611 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2273
Practice Address - Country:US
Practice Address - Phone:313-832-6300
Practice Address - Fax:313-832-2075
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DETROIT COMMUNITY HEALTH CONNECTION, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-02-20
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center