Basic Information
| Provider Information | |||||||||
| NPI: | 1679571392 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DOWNRIVER COMMUNITY SERVICES, INC. | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | COMMUNITY FIRST HEALTH CENTERS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 480430 | ||||||||
| Address2: | |||||||||
| City: | NEW HAVEN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48048 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5867495197 | ||||||||
| FaxNumber: | 5867495560 | ||||||||
| Practice Location | |||||||||
| Address1: | 58144 GRATIOT AVENUE | ||||||||
| Address2: | |||||||||
| City: | NEW HAVEN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48048 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5867495197 | ||||||||
| FaxNumber: | 5867495560 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2005 | ||||||||
| LastUpdateDate: | 03/02/2017 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BRANOWSKI | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5867495197 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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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.