Provider Demographics
| NPI: | 1861193138 |
|---|---|
| Name: | DENSON EL CENTERS FOR RECOVERY SUPPORT SERVICES |
| Entity type: | Organization |
| Organization Name: | DENSON EL CENTERS FOR RECOVERY SUPPORT SERVICES |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | MEDICAL DIRECTOR |
| Authorized Official - Prefix: | MR |
| Authorized Official - First Name: | T'MANDO |
| Authorized Official - Middle Name: | A |
| Authorized Official - Last Name: | DENSON-EL |
| Authorized Official - Suffix: | SR |
| Authorized Official - Credentials: | MD, CPRM, SBIRT, CCR |
| Authorized Official - Phone: | 313-293-1609 |
| Mailing Address - Street 1: | 6551 GRAND RIVER AVE |
| Mailing Address - Street 2: | |
| Mailing Address - City: | DETROIT |
| Mailing Address - State: | MI |
| Mailing Address - Zip Code: | 48208-1125 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 313-293-1609 |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 15771 MACK AVE |
| Practice Address - Street 2: | |
| Practice Address - City: | DETROIT |
| Practice Address - State: | MI |
| Practice Address - Zip Code: | 48224-3497 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 844-462-8423 |
| Practice Address - Fax: | 313-774-2956 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2023-03-14 |
| Last Update Date: | 2023-03-30 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 251S00000X | Agencies | Community/Behavioral Health | Group - Multi-Specialty | |
| No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
| No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
| No | 103TA0400X | Behavioral Health & Social Service Providers | Psychologist | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
| No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
| No | 163WA0400X | Nursing Service Providers | Registered Nurse | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
| No | 163WG0000X | Nursing Service Providers | Registered Nurse | General Practice | Group - Multi-Specialty |
| No | 175T00000X | Other Service Providers | Peer Specialist | Group - Multi-Specialty | |
| No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
| No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
| No | 251B00000X | Agencies | Case Management | ||
| No | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | |
| No | 320800000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness | ||
| No | 385H00000X | Respite Care Facility | Respite Care | ||
| No | 405300000X | Other Service Providers | Prevention Professional | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| MI | 1679014864 | Medicaid | |
| MI | 1770746901 | Medicaid | |
| MI | 1174632145 | Medicaid | |
| MI | 1255651717 | Medicaid | |
| MI | 1346635018 | Medicaid | |
| MI | 1730760034 | Medicaid | |
| MI | 1336429224 | Medicaid | |
| MI | 159828090 | Medicaid | |
| MI | 1649382474 | Medicaid | |
| MI | 1699755173 | Medicaid |
