Provider Demographics
NPI:1891907721
Name:COMMUNITY SOCIAL SERVICES OF WAYNE COUNTY
Entity Type:Organization
Organization Name:COMMUNITY SOCIAL SERVICES OF WAYNE COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:HERON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-883-2339
Mailing Address - Street 1:9851 HAMILTON AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-1424
Mailing Address - Country:US
Mailing Address - Phone:313-883-2100
Mailing Address - Fax:313-883-3957
Practice Address - Street 1:9851 HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-1424
Practice Address - Country:US
Practice Address - Phone:313-883-2100
Practice Address - Fax:313-883-3957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISA0820021251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI750910628OtherBLUE CROSS BLUE SHIELD
MI750913628OtherBLUE CROSS BLUE SHIELD
ME125551OtherBEACON HEALTH OPTIONS