Provider Demographics
NPI:1285735845
Name:DETROIT HEALTH CARE FOR THE HOMELESS
Entity type:Organization
Organization Name:DETROIT HEALTH CARE FOR THE HOMELESS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INTERIM EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SOARES
Authorized Official - Suffix:
Authorized Official - Credentials:MPH, RN
Authorized Official - Phone:313-255-3333
Mailing Address - Street 1:20548 FENKELL
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48223
Mailing Address - Country:US
Mailing Address - Phone:313-255-3333
Mailing Address - Fax:313-255-8679
Practice Address - Street 1:20548 FENKELL
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48223
Practice Address - Country:US
Practice Address - Phone:313-255-3333
Practice Address - Fax:313-255-8679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N76890Medicare PIN
MI0N77550Medicare PIN