Provider Demographics
NPI:1588137376
Name:DETROIT COMMUNITY HEALTH CONNECTION, INC
Entity type:Organization
Organization Name:DETROIT COMMUNITY HEALTH CONNECTION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR VP & CFO
Authorized Official - Prefix:
Authorized Official - First Name:MAHIPAL
Authorized Official - Middle Name:RAO
Authorized Official - Last Name:KAKARALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-821-2591
Mailing Address - Street 1:13901 E JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48215-2720
Mailing Address - Country:US
Mailing Address - Phone:313-821-2591
Mailing Address - Fax:313-822-4202
Practice Address - Street 1:20303 KELLY RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48225-1206
Practice Address - Country:US
Practice Address - Phone:313-347-2116
Practice Address - Fax:313-245-7009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-04
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)