Provider Demographics
NPI:1386705804
Name:HEALTH CENTERS DETROIT FOUNDATION, INC.
Entity type:Organization
Organization Name:HEALTH CENTERS DETROIT FOUNDATION, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:SMITHERMAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:313-966-5187
Mailing Address - Street 1:23077 GREENFIELD RD STE 489
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-3740
Mailing Address - Country:US
Mailing Address - Phone:248-423-3900
Mailing Address - Fax:248-423-8169
Practice Address - Street 1:23077 GREENFIELD RD STE 489
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-3740
Practice Address - Country:US
Practice Address - Phone:248-423-3900
Practice Address - Fax:248-423-8169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N71990Medicare PIN