Provider Demographics
NPI:1790373579
Name:CENTRAL CARE MANAGEMENT ORGANIZATION
Entity Type:Organization
Organization Name:CENTRAL CARE MANAGEMENT ORGANIZATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PREVENTION DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:REGINALD
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:TERRY
Authorized Official - Suffix:SR
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:313-875-2092
Mailing Address - Street 1:3031 W GRAND BLVD STE 370
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:313-875-2092
Mailing Address - Fax:313-875-2146
Practice Address - Street 1:3031 W GRAND BLVD STE 370
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-3008
Practice Address - Country:US
Practice Address - Phone:313-875-2092
Practice Address - Fax:313-875-2092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes405300000XOther Service ProvidersPrevention ProfessionalGroup - Single Specialty
No251B00000XAgenciesCase Management