Provider Demographics
NPI:1376200865
Name:PUBLIC POPULAR HEALTH LLC
Entity Type:Organization
Organization Name:PUBLIC POPULAR HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LAYLA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:313-449-7954
Mailing Address - Street 1:252 W LONGWOOD PL
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48203-5210
Mailing Address - Country:US
Mailing Address - Phone:313-449-7954
Mailing Address - Fax:
Practice Address - Street 1:252 W LONGWOOD PL
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48203-5210
Practice Address - Country:US
Practice Address - Phone:313-449-7954
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-19
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service