WOODWARD BOULEVARD MEDICAL BLDG., LLC. (NPI# 1689151946) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1689151946 |
| Entity Type | Organization |
| Organization Name | WOODWARD BOULEVARD MEDICAL BLDG., LLC. |
| Practice Address |
5830 Conner St Detroit MI 48213-3458 |
| Practice Telephone | 3139241456 |
| Practice Fax Number | 3136362290 |
| Mailing Telephone | 3139241456 |
| Mailing Fax Number | 3136362290 |
| Enumeration Date | 2018-07-19 |
| Last Update Date | 2018-07-19 |
| Authorized Official Name | MRS. LATONYA WALLACE-HARDIMAN (OFFICE MANAGER) |
| Authorized Official Telephone | 3139241456 |
| Authorized Official Credential | BA, MS. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261Q00000X | Clinic/Center | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | N/A | 1053818039 | 01 |
| Street Address |
5830 CONNER ST |
| City | DETROIT |
| State | MI |
| Zip Code | 48213-3458 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255442190 | Life- Alysis Kidney Center, LLC | Health Maintenance Organization | 5830 Conner St, Detroit, MI 48213-3458 | 2006-08-31 |
| 1568079697 | One Step At A Time Physical Therapy, L.L.C. | Clinic/Center | 5830 Conner St, Detroit, MI 48213-3458 | 2020-09-23 |
| 1053818039 | Latonya Wallace-hardiman | Clinic/Center | 5830 Conner St, Detroit, MI 48213-3458 | 2018-04-06 |
| 1437374030 | Suezette Olaker | Family Medicine | 5830 Conner St, Detroit, MI 48213 | 2007-04-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215540430 | Sheronda Lanetta Blackmon | Licensed Practical Nurse | 13929 Harper Ave., Detroit, MI 48213 | 2020-08-27 |
| 1073049144 | Cheryl Williams | Community Health Worker | 13929 Chalmers Ave., Detroit, MI 48213 | 2017-05-10 |
| 1164963401 | Smile Fresh Detroit PC | Dentist | 7230 Gratiot Avenue, Detroit, MI 48213 | 2017-03-20 |
| 1255887899 | Jay Washington | Behavioral Analyst | 9146 Haper, Detroit, MI 48213 | 2016-09-01 |
| 1396129532 | Sarietha King | Home Health | 14639 Manistique, Detroit, MI 48213 | 2015-07-17 |
| 1366823197 | Royal Treatment Mental Health Systems, LLC | Counselor | 5555 Corner Avenue, Detroit, MI 48213 | 2015-06-17 |
| 1477956779 | Monique Powell | Student in an Organized Health Care Education/Training Program | 5801 Lakeview S.t, Detroit, MI 48213 | 2014-09-30 |
| 1629339163 | Samuel Joseph Farmer | Counselor | 10100 Harper Ave., Detroit, MI 48213 | 2012-05-31 |
| 1609164755 | Vernon Keith Johnson | Social Worker | 20203 Kelly Road, Detroit, MI 48213 | 2011-07-11 |
| 1023312790 | Davenport Quality Home Care LLC | Home Health | 5027 Maxwell, Detroit, MI 48213 | 2011-01-10 |
| Find all providers in zip 48213 | ||||
| Taxonomy Code | 261Q00000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952909558 | Quilted Rose Clinical Services, Pllc | Clinic/Center | 269 Walker St Ste 256, Detroit, MI 48207-4258 | 2020-10-15 |
| 1851920581 | Emotional Wellness Group LLC | Clinic/Center | 11956 E Outer Dr, Detroit, MI 48224-2630 | 2020-04-04 |
| 1245897503 | Healthy Choice Community Centered Counseling LLC | Clinic/Center | 19300 Greenfield Rd Ste B, Detroit, MI 48235-2003 | 2019-05-22 |
| 1891245775 | Platinum Psychological Services | Clinic/Center | 4777 E Outer Dr Ste 1154, Detroit, MI 48234-3241 | 2016-10-04 |
| 1750837324 | A Plus Care Transportation LLC | Clinic/Center | 14586 Wisconsin, Detroit, MI 48238 | 2016-09-01 |
| 1093157802 | Medical Massage Clinic of Mi., LLC | Clinic/Center | 17151 Wyoming St, Detroit, MI 48221-2451 | 2013-07-22 |
| 1033461728 | Caring Hands Medical Clinical, P.C. | Clinic/Center | 14219 W. Mc Nichols Road, Detroit, MI 48235 | 2012-10-05 |
| 1558619510 | St John Providence Eastwood Clinic | Clinic/Center | 4777 E Outer Dr Ste 1105, Detroit, MI 48234-3241 | 2012-08-23 |
| 1497997068 | Med Care Clinic LLC | Clinic/Center | 16315 Grand River Ave, Detroit, MI 48227-1825 | 2009-03-29 |
| 1841448446 | Theramatrix, Inc. | Clinic/Center | 18601 Mack Avenue #3, Detroit, MI 48236-3250 | 2008-09-08 |
| Find all providers in DETROIT | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.