Basic Information
| Provider Information | |||||||||
| NPI: | 1174906184 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DETROIT COMMUNITY HEALTH CONNECTION, INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | DCHC HOSPITAL CARE | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13901 E JEFFERSON AVE | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482152720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3133432873 | ||||||||
| FaxNumber: | 3138224202 | ||||||||
| Practice Location | |||||||||
| Address1: | 13901 E JEFFERSON AVE | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482152720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3133432873 | ||||||||
| FaxNumber: | 3138224202 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2015 | ||||||||
| LastUpdateDate: | 07/29/2015 | ||||||||
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| AuthorizedOfficialLastName: | KAKARALA | ||||||||
| AuthorizedOfficialFirstName: | MAHIPAL | ||||||||
| AuthorizedOfficialMiddleName: | RAO | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 3138212591 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
No ID Information.