Provider Demographics
NPI:1750104071
Name:DETROIT COMMUNITY CARE NETWORK L3C
Entity type:Organization
Organization Name:DETROIT COMMUNITY CARE NETWORK L3C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:UNDERWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-636-1801
Mailing Address - Street 1:21549 VIRGINIA ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-2364
Mailing Address - Country:US
Mailing Address - Phone:313-636-1801
Mailing Address - Fax:
Practice Address - Street 1:12850 PLYMOUTH RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48227-3725
Practice Address - Country:US
Practice Address - Phone:313-636-1801
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-05
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare