Detroit Wayne County Health Authority

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

DETROIT WAYNE COUNTY HEALTH AUTHORITY

Practice address

23077 Greenfield Rd Ste 200
Southfield, MI 48075-3750

Phone

(313) 824-1000

Fax

(248) 569-9151

NPI assigned

Feb 13, 2026

Last updated

Feb 13, 2026By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Loretta Violet Bush

Title

Ceo

Phone

(313) 824-1000

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1063364776. Details of each certification follow.

• CCN C71056 Federally qualified health center · Active · Details

Federally qualified health center certification: CCN C71056

Legal name

DETROIT WAYNE COUNTY HEALTH AUTHORITY

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Mar 18, 2026

Last certification

Mar 18, 2026

Ownership / control type

For profit – corporation

Organization structure

CorporationNon-profit

Enrollment address

23077 Greenfield Rd
Ste 200
Southfield, MI 48075-3750

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Detroit Wayne County Health Authority

  • Federally Qualified Health Center (FQHC)
  • Detroit, MI
  • NPI 1245182963

  4385982271

  Same PAC ID
• Detroit Wayne County Health Authority

  • Federally Qualified Health Center (FQHC)
  • Detroit, MI
  • NPI 1508718248

  4385982271

  Same PAC ID
• Detroit Wayne County Health Authority

  • Primary Care Clinic/Center
  • Detroit, MI
  • NPI 1962733089

  4385982271

  Same PAC ID

Tax ID family

Detroit Wayne County Health Authority3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Detroit Wayne County Health Authority

  • Federally Qualified Health Center (FQHC)
  • Detroit, MI
  • NPI 1245182963
  NPD tax ID
• Detroit Wayne County Health Authority

  • Federally Qualified Health Center (FQHC)
  • Detroit, MI
  • NPI 1508718248
  NPD tax ID

All disclosed owners & managing parties 4

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1770940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1770940800000",
    "number": "1063364776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23077 GREENFIELD RD STE 200",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480753750",
            "telephone_number": "313-824-1000",
            "fax_number": "248-569-9151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23077 GREENFIELD RD STE 200",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480753750",
            "telephone_number": "313-824-1000",
            "fax_number": "248-569-9151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DETROIT WAYNE COUNTY HEALTH AUTHORITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-02-13",
        "last_updated": "2026-02-13",
        "certification_date": "2026-02-13",
        "status": "A",
        "authorized_official_last_name": "BUSH",
        "authorized_official_first_name": "LORETTA",
        "authorized_official_middle_name": "VIOLET",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "313-824-1000"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Detroit Integrated Care
• Detroit Medical Care PC
• Detroit Medical Equipment Inc
• Detroit Orthopedics & Sports Medicine PLC
• Detroit Vamc
• Naya Deutsch
• Shivakumar Deva, MD
• Jaronique Danielle Devezin, EDD
• Devine Home Health Care Agency LLC
• Jeffrey Walter Devitt Jr., M.D.

• Federally Qualified Health Center (FQHC) in Southfield, MI
• Providers in Southfield, MI by specialty
• Federally Qualified Health Center (FQHC) in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.