1710145818 NPI number — DEVELOPMENT CENTERS, INC.

Table of content: (NPI 1710145818)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710145818 NPI number — DEVELOPMENT CENTERS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DEVELOPMENT CENTERS, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710145818
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/24/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17421 TELEGRAPH RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DETROIT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48219-3165
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-531-2500
Provider Business Mailing Address Fax Number:
313-255-3471

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17321 TELEGRAPH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-531-2500
Provider Business Practice Location Address Fax Number:
313-255-3471
Provider Enumeration Date:
05/27/2008

Additional Information

Authorized Official

Authorized Official Last Name:
LIESMAN
Authorized Official First Name:
CATHERINE
Authorized Official Middle Name:
LOUISE
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
313-531-2500

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 750910508 . This is a "BCBSM STATE EMPL CHILD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 750910618 . This is a "BCBSM STATE EMPL ADULT" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 800H217310 . This is a "BCBS - CSW GROUP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: P94406 . This is a "BLUE CARE NETWORK" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 024951 . This is a "MIDWEST HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 260Q276040 . This is a "BCBS - DOCTOR GROUP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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