| Detroit Community Health Connection, Inc | |
|
20303 Kelly Rd Detroit MI 48225-1206 | |
| (313) 347-2116 | |
| (313) 245-7009 |
| Full Name | Detroit Community Health Connection, Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 20303 Kelly Rd, Detroit, Michigan |
| Authorized Official Name and Position | Mahipal Rao Kakarala (SR VP & CFO) |
| Authorized Official Contact | 3138212591 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Detroit Community Health Connection, Inc 13901 E Jefferson Ave Detroit MI 48215-2720 Ph: (313) 821-2591 | Detroit Community Health Connection, Inc 20303 Kelly Rd Detroit MI 48225-1206 Ph: (313) 347-2116 |
| NPI Number | 1588137376 |
|---|---|
| Provider Enumeration Date | 01/04/2019 |
| Last Update Date | 01/04/2019 |
| Medicare PECOS PAC ID | 9234021148 |
|---|---|
| Medicare Enrollment ID | O20190218001615 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588137376 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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