Provider Demographics
NPI:1336995133
Name:DETROIT CENTRAL CITY COMMUNITY MENTAL HEALTH, INC.
Entity Type:Organization
Organization Name:DETROIT CENTRAL CITY COMMUNITY MENTAL HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REVENUE CYCLE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VALENCIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:FRANK
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, BS, SATS
Authorized Official - Phone:313-635-4213
Mailing Address - Street 1:10 PETERBORO ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2722
Mailing Address - Country:US
Mailing Address - Phone:313-831-3160
Mailing Address - Fax:
Practice Address - Street 1:1240 3RD ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48226-2505
Practice Address - Country:US
Practice Address - Phone:313-635-4213
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-24
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)