Provider Demographics
NPI:1598934416
Name:DETROIT RECOVERY PROJECT, INC
Entity Type:Organization
Organization Name:DETROIT RECOVERY PROJECT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:313-876-0770
Mailing Address - Street 1:1151 TAYLOR ST
Mailing Address - Street 2:SUITE 417
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-1732
Mailing Address - Country:US
Mailing Address - Phone:313-876-0770
Mailing Address - Fax:313-876-0913
Practice Address - Street 1:1151 TAYLOR ST
Practice Address - Street 2:SUITE 417
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-1732
Practice Address - Country:US
Practice Address - Phone:313-876-0770
Practice Address - Fax:313-876-0913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-25
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI822974251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health