Provider Demographics
NPI:1457469140
Name:DETROIT PUBLIC SCHOOLS
Entity Type:Organization
Organization Name:DETROIT PUBLIC SCHOOLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAID COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:ELKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-873-4283
Mailing Address - Street 1:7313 2ND AVE
Mailing Address - Street 2:FISHER BUILDING, 11TH FLOOR
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-2710
Mailing Address - Country:US
Mailing Address - Phone:313-873-4283
Mailing Address - Fax:
Practice Address - Street 1:7313 2ND AVE
Practice Address - Street 2:FISHER BUILDING, 11TH FLOOR
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2710
Practice Address - Country:US
Practice Address - Phone:313-873-4283
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3454357Medicaid