Provider Demographics
NPI:1962733089
Name:DETROIT WAYNE COUNTY HEALTH AUTHORITY
Entity type:Organization
Organization Name:DETROIT WAYNE COUNTY HEALTH AUTHORITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-871-3751
Mailing Address - Street 1:3031 W GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-3046
Mailing Address - Country:US
Mailing Address - Phone:313-824-1000
Mailing Address - Fax:313-824-9000
Practice Address - Street 1:10809 MACK AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48214-2119
Practice Address - Country:US
Practice Address - Phone:313-824-1000
Practice Address - Fax:313-824-9000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-29
Last Update Date:2025-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QH0100X, 3336C0002X, 261Q00000X, 261QM0855X, 251S00000X, 261QP2300X, 261QC1500X, 261QF0400X
251K00000X251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No3336C0002XSuppliersPharmacyClinic Pharmacy
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No251S00000XAgenciesCommunity/Behavioral Health
No251K00000XAgenciesPublic Health or Welfare
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health