Provider Demographics
NPI:1396839981
Name:DETROIT HEALTH CARE FOR THE HOMELESS
Entity Type:Organization
Organization Name:DETROIT HEALTH CARE FOR THE HOMELESS
Other - Org Name:ADVANTAGE HEALTH CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABUBAKARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-416-6259
Mailing Address - Street 1:100 RIVER PLACE DR STE 450
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48207-5402
Mailing Address - Country:US
Mailing Address - Phone:313-416-6262
Mailing Address - Fax:313-221-8217
Practice Address - Street 1:60 E WARREN AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-1312
Practice Address - Country:US
Practice Address - Phone:313-416-6261
Practice Address - Fax:313-221-8217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704118498261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N77550Medicare PIN
MI0N76890Medicare PIN