Provider Demographics
NPI:1275802258
Name:DETROIT HEALTH CARE FOR THE HOMELESS
Entity Type:Organization
Organization Name:DETROIT HEALTH CARE FOR THE HOMELESS
Other - Org Name:AHC FQHC FFS ONLY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:NINA
Authorized Official - Middle Name:W
Authorized Official - Last Name:ABUKARIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-416-6200
Mailing Address - Street 1:100 RIVER PLACE
Mailing Address - Street 2:TALON CENTRE BLDG
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48203-3724
Mailing Address - Country:US
Mailing Address - Phone:313-835-5990
Mailing Address - Fax:313-221-8217
Practice Address - Street 1:15400 W MCNICHOLS RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-3724
Practice Address - Country:US
Practice Address - Phone:313-835-5990
Practice Address - Fax:313-221-8217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-21
Last Update Date:2017-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)