Provider Demographics
NPI:1225274749
Name:DETROIT RECOVERY PROJECT
Entity Type:Organization
Organization Name:DETROIT RECOVERY PROJECT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-876-0770
Mailing Address - Street 1:1151 TAYLOR ST
Mailing Address - Street 2:ROOM 304B
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-1732
Mailing Address - Country:US
Mailing Address - Phone:313-876-0770
Mailing Address - Fax:313-876-0913
Practice Address - Street 1:18954 JAMES COUZENS FWY
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-2516
Practice Address - Country:US
Practice Address - Phone:313-864-5306
Practice Address - Fax:313-864-5326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-06
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health