1417178609 NPI number — COMMUNITY SOCIAL SERVICES OF WAYNE COUNTY

Table of content: (NPI 1417178609)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417178609 NPI number — COMMUNITY SOCIAL SERVICES OF WAYNE COUNTY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY SOCIAL SERVICES OF WAYNE COUNTY
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:
1417178609
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/04/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9851 HAMILTON AVE
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:
48202-1424
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-883-2100
Provider Business Mailing Address Fax Number:
313-883-3957

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19855 WEST OUTER DR
Provider Second Line Business Practice Location Address:
SUITE 207-E
Provider Business Practice Location Address City Name:
DEARBORN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48124-2028
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-792-9286
Provider Business Practice Location Address Fax Number:
313-792-0444
Provider Enumeration Date:
05/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HERON
Authorized Official First Name:
PATRICK
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT & CEO
Authorized Official Telephone Number:
313-883-2339

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  820537 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com