1861193138 NPI number — DENSON EL CENTERS FOR RECOVERY SUPPORT SERVICES

Table of content: (NPI 1861193138)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861193138 NPI number — DENSON EL CENTERS FOR RECOVERY SUPPORT SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DENSON EL CENTERS FOR RECOVERY SUPPORT SERVICES
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:
6
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:
1861193138
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/30/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6551 GRAND RIVER 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:
48208-1125
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-293-1609
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15771 MACK AVE
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:
48224-3497
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
844-462-8423
Provider Business Practice Location Address Fax Number:
313-774-2956
Provider Enumeration Date:
03/14/2023

Additional Information

Authorized Official

Authorized Official Last Name:
DENSON-EL
Authorized Official First Name:
T'MANDO
Authorized Official Middle Name:
A
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
313-293-1609

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TA0400X ; 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: 163WA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WG0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 175T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 320800000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 385H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 405300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1679014864 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1770746901 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1174632145 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1255651717 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1346635018 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1730760034 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1336429224 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 159828090 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1649382474 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1699755173 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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