Provider Demographics
NPI:1568703221
Name:WAYNE COUNTY HEALTHY COMMUNITIES
Entity Type:Organization
Organization Name:WAYNE COUNTY HEALTHY COMMUNITIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OF HEALTH OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:MOUHANAD
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMMAMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-224-0810
Mailing Address - Street 1:500 GRISWOLD ST
Mailing Address - Street 2:10 SOUTH
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48226-3480
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11447 JOSEPH CAMPAU ST
Practice Address - Street 2:
Practice Address - City:HAMTRAMCK
Practice Address - State:MI
Practice Address - Zip Code:48212-3040
Practice Address - Country:US
Practice Address - Phone:313-595-1362
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WAYNE COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-03-06
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)