Provider Demographics
NPI:1518235670
Name:URBAN HEALTH RESOURCE
Entity Type:Organization
Organization Name:URBAN HEALTH RESOURCE
Other - Org Name:URBAN HEALTH RESOURCE, INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:S
Authorized Official - Last Name:GREEN-SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:313-664-0100
Mailing Address - Street 1:3031 W GRAND BLVD STE 531
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-3008
Mailing Address - Country:US
Mailing Address - Phone:313-664-0100
Mailing Address - Fax:313-664-0111
Practice Address - Street 1:3031 W GRAND BLVD
Practice Address - Street 2:STE 365
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202
Practice Address - Country:US
Practice Address - Phone:313-664-0100
Practice Address - Fax:313-664-0111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-05
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty
No171W00000XOther Service ProvidersContractorGroup - Multi-Specialty
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI12245Medicaid