| Modern Health Connections Llc | |
|
11383 Mark Twain St Detroit MI 48227-3051 | |
| (313) 506-5739 | |
| Not Available |
| Full Name | Modern Health Connections Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 11383 Mark Twain St, Detroit, Michigan |
| Authorized Official Name and Position | Amir Bracken (OWNER) |
| Authorized Official Contact | 3133772018 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Modern Health Connections Llc 11383 Mark Twain St Detroit MI 48227-3051 Ph: (313) 506-5739 | Modern Health Connections Llc 11383 Mark Twain St Detroit MI 48227-3051 Ph: (313) 506-5739 |
| NPI Number | 1558015255 |
|---|---|
| Provider Enumeration Date | 02/10/2022 |
| Last Update Date | 07/02/2022 |
| Certification Date | 07/02/2022 |
| Medicare PECOS PAC ID | 8224414545 |
|---|---|
| Medicare Enrollment ID | O20221010002138 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558015255 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Primary |
| Provider Name | Odette A Ngalla |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194488858 PECOS PAC ID: 7719361120 Enrollment ID: I20221006001651 |
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