Provider Demographics
NPI:1417384223
Name:COMMUNITY HEALTH AWARENESS GROUP
Entity Type:Organization
Organization Name:COMMUNITY HEALTH AWARENESS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLINICAL SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:FLUKER
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:313-963-3434
Mailing Address - Street 1:1300 W FORT ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48226-3007
Mailing Address - Country:US
Mailing Address - Phone:313-963-3434
Mailing Address - Fax:313-963-1832
Practice Address - Street 1:1300 W FORT ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48226-3007
Practice Address - Country:US
Practice Address - Phone:313-963-3434
Practice Address - Fax:313-963-1832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-11
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801071630251S00000X
343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)