1326135047 NPI number — DEVELOPMENT CENTERS, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326135047 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:
1326135047
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:
313-255-3465

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24424 W MCNICHOLS 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:
313-255-3465
Provider Enumeration Date:
10/06/2006

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • 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: 750910618 . This is a "BCBSM STATE EMPL ADULT" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 750910508 . This is a "BCBSM STATE EMPL CHILD" 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: 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".
  • Identifier: P94406 . This is a "BLUE CARE NETWORK" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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