Basic Information
| Provider Information | |||||||||
| NPI: | 1588672091 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEW CENTER COMMUNITY MENTAL HEALTH SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2051 W. GRAND BLVD. | ||||||||
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| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482080115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3139613373 | ||||||||
| FaxNumber: | 3139613369 | ||||||||
| Practice Location | |||||||||
| Address1: | 2051 W GRAND BLVD | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482081105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3139613200 | ||||||||
| FaxNumber: | 3139613769 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2006 | ||||||||
| LastUpdateDate: | 04/19/2018 | ||||||||
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| AuthorizedOfficialLastName: | CALLOWAY | ||||||||
| AuthorizedOfficialFirstName: | JOY | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | C.E.O. | ||||||||
| AuthorizedOfficialTelephone: | 3139613373 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
ID Information
| ID | Type | State | Issuer | Description | 1706437 | 05 | MI | MEDICAID |