Provider Demographics
NPI:1669771432
Name:DETROIT CENTER FOR CARE
Entity type:Organization
Organization Name:DETROIT CENTER FOR CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:SANYANI
Authorized Official - Middle Name:DONNELL
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:LLP
Authorized Official - Phone:248-677-1564
Mailing Address - Street 1:PO BOX 44446
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48244-0446
Mailing Address - Country:US
Mailing Address - Phone:248-677-1564
Mailing Address - Fax:248-213-6386
Practice Address - Street 1:511 E GRAND BLVD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207-3636
Practice Address - Country:US
Practice Address - Phone:248-677-1564
Practice Address - Fax:248-213-6386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-20
Last Update Date:2011-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health