Provider Demographics
NPI:1659151025
Name:COMMUNITY HEALTH AND SOCIAL SERVICES CENTER, INC
Entity type:Organization
Organization Name:COMMUNITY HEALTH AND SOCIAL SERVICES CENTER, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:FELIX
Authorized Official - Middle Name:MARIO
Authorized Official - Last Name:VALBUENA
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:313-849-3920
Mailing Address - Street 1:5635 W FORT ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48209-3154
Mailing Address - Country:US
Mailing Address - Phone:313-849-3920
Mailing Address - Fax:313-849-0824
Practice Address - Street 1:1761 WATERMAN ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48209-2194
Practice Address - Country:US
Practice Address - Phone:313-849-3920
Practice Address - Fax:313-849-3920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-03
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)