Provider Demographics
NPI:1417178609
Name:COMMUNITY SOCIAL SERVICES OF WAYNE COUNTY
Entity Type:Organization
Organization Name:COMMUNITY SOCIAL SERVICES OF WAYNE COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:HERON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-883-2339
Mailing Address - Street 1:9851 HAMILTON AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-1424
Mailing Address - Country:US
Mailing Address - Phone:313-883-2100
Mailing Address - Fax:313-883-3957
Practice Address - Street 1:19855 WEST OUTER DR
Practice Address - Street 2:SUITE 207-E
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2028
Practice Address - Country:US
Practice Address - Phone:313-792-9286
Practice Address - Fax:313-792-0444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI820537251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
0Q27000Medicare ID - Type Unspecified