| Detroit Recovery Project, Inc | |
|
1145 W Grand Blvd Detroit MI 48208-2336 | |
| (313) 324-8722 | |
| (313) 365-3098 |
| Full Name | Detroit Recovery Project, Inc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 1145 W Grand Blvd, Detroit, Michigan |
| Authorized Official Name and Position | Kanzoni N Asabigi (VICE PRESIDENT) |
| Authorized Official Contact | 3133248900 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Detroit Recovery Project, Inc 1145 W Grand Blvd Detroit MI 48208-2336 Ph: (313) 324-8722 | Detroit Recovery Project, Inc 1145 W Grand Blvd Detroit MI 48208-2336 Ph: (313) 324-8722 |
| NPI Number | 1760890263 |
|---|---|
| Provider Enumeration Date | 07/28/2014 |
| Last Update Date | 07/01/2020 |
| Certification Date | 07/01/2020 |
| Medicare PECOS PAC ID | 1850716226 |
|---|---|
| Medicare Enrollment ID | O20200731002030 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760890263 | NPI | - | NPPES |
| 1760890263 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | SA0823206 (Michigan) | Primary |
| Provider Name | David F Williams |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1710022017 PECOS PAC ID: 3173671302 Enrollment ID: I20090428000300 |
| Provider Name | Atul C Shah |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1881729978 PECOS PAC ID: 3274788377 Enrollment ID: I20130220000543 |
| Provider Name | Jennifer Rose Robinson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1740568377 PECOS PAC ID: 4284937756 Enrollment ID: I20160119000187 |
| Provider Name | Myele L Williamson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164998431 PECOS PAC ID: 3971848136 Enrollment ID: I20181218000072 |
| Provider Name | Monique N Gaines |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1720433097 PECOS PAC ID: 0345651204 Enrollment ID: I20201124003158 |
| Provider Name | Lauren L Judd |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265176507 PECOS PAC ID: 2365898863 Enrollment ID: I20231019000660 |
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