Basic Information
| Provider Information | |||||||||
| NPI: | 1649820986 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WESTERN WAYNE FAMILY HEALTH CENTERS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2700 HAMLIN BLVD | ||||||||
| Address2: | |||||||||
| City: | INKSTER | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481412206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3135615100 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4700 SCHAEFER RD | ||||||||
| Address2: | |||||||||
| City: | DEARBORN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481263655 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3135615100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/18/2019 | ||||||||
| LastUpdateDate: | 09/18/2019 | ||||||||
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| AuthorizedOfficialLastName: | ATKINS | ||||||||
| AuthorizedOfficialFirstName: | LINDA | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 3135615100 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | WESTERN WAYNE FAMILY HEALTH CENTERS | ||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | RN | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
No ID Information.