Provider Demographics
NPI:1851399570
Name:DOWNRIVER COMMUNITY SERVICES, INC.
Entity Type:Organization
Organization Name:DOWNRIVER COMMUNITY SERVICES, INC.
Other - Org Name:COMMUNITY FIRST HEALTH CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:BARANOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-749-5197
Mailing Address - Street 1:555 ST CLAIR RIVER DRIVE
Mailing Address - Street 2:
Mailing Address - City:ALGONAC
Mailing Address - State:MI
Mailing Address - Zip Code:48001
Mailing Address - Country:US
Mailing Address - Phone:810-794-4982
Mailing Address - Fax:810-794-4407
Practice Address - Street 1:555 SAINT CLAIR RIVER DR
Practice Address - Street 2:
Practice Address - City:ALGONAC
Practice Address - State:MI
Practice Address - Zip Code:48001-1802
Practice Address - Country:US
Practice Address - Phone:810-794-4982
Practice Address - Fax:810-794-4407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-08
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI231820Medicare Oscar/Certification
MION25400Medicare PIN