Organization
DETROIT COMMUNITY HEALTH CONNECTION, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MAHIPAL RAO KAKARALA (CFO)
(313) 821-2591
Entity
Organization
Contact information
Practice address
13901 E JEFFERSON AVE, DETROIT, MI 48215-2720
(313) 822-0900
(313) 822-0950
Mailing address
13901 E JEFFERSON AVE, DETROIT, MI 48215-2720
(313) 821-2591
(313) 822-4202
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1982611562
NPI
—
05
—
1992196
—
MI
Enumeration date
08/03/2006
Last updated
06/24/2015
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