Provider Demographics
NPI:1790018489
Name:DERRICK COMMUNITY DEVELOPMENT & HUMAN SERVICES
Entity Type:Organization
Organization Name:DERRICK COMMUNITY DEVELOPMENT & HUMAN SERVICES
Other - Org Name:DCDHS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT, CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:DERRICK
Authorized Official - Suffix:
Authorized Official - Credentials:BSHCS
Authorized Official - Phone:313-915-2644
Mailing Address - Street 1:PO BOX 252982
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48325-2982
Mailing Address - Country:US
Mailing Address - Phone:313-915-2644
Mailing Address - Fax:248-661-5024
Practice Address - Street 1:5010 31ST ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48210-2537
Practice Address - Country:US
Practice Address - Phone:313-915-2644
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-12
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities