NPIMap

Organization Active NPI

Detroit Central City Community Mental Health Inc.

Doing business as Central City Health

  • Federally Qualified Health Center (FQHC)
  • Detroit, MI
National Provider Identifier
1285043406
Registry record updated Jul 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
702008 Issued in MI
Legal business name
DETROIT CENTRAL CITY COMMUNITY MENTAL HEALTH INC.
Doing business as
Central City Health
Central City Integrated Health
Practice address
10 Peterboro St
Detroit, MI 48201-2722
Phone
(313) 831-3160
Fax
(313) 833-2604
NPI assigned
Aug 13, 2014
Last updated
Jul 11, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2024

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

Authorized official

Name
Michelle Riley
Title
Credentialing Specialist
Phone
(313) 221-8595

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 702008 MI Primary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X

Addresses

Primary practice location

10 Peterboro St
Detroit, MI 48201-2722

Mailing address

10 Peterboro St
Detroit, MI 48201-2722
Phone (313) 831-3160

Other practice location 1

14751 Mansfield St
Detroit, MI 48227-1801
Phone (313) 831-3160

Other practice location 2

130 E Grand Blvd
Detroit, MI 48207-3713
Phone (313) 831-3160

Other practice location 3

8333 Townsend St
Detroit, MI 48213-2331
Phone (313) 831-3160

Other practice location 4

2700 Martin Luther King Jr Blvd Ste 11401
Detroit, MI 48208-2576
Phone (313) 831-3160

Other practice location 5

4777 E Outer Dr
Detroit, MI 48234-3241
Phone (313) 831-3160

Other practice location 6

1240 3rd St
Detroit, MI 48226-2505
Phone (313) 831-3160

Other identifiers 1

IdentifierTypeStateIssuer
1285043406MedicaidMI

Other names 2

  • Central City Health Doing business as
  • Central City Integrated Health Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20101109001334 MI Part B Supplier - Clinic/Group Practice 3274728829 Receives reassigned benefits from 34 practitioners
4 other NPIs on this enrollment
Practice locations: Detroit, MI
O20240501000222 MI Part A Provider - Federally Qualified Health Center (FQHC) 3274728829 2 other NPIs on this enrollment
Practice locations: Detroit, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1285043406. Details of each certification follow.

Federally qualified health center certification: CCN C71022

Legal name
DETROIT CENTRAL CITY COMMUNITY MENTAL HEALTH INC
Doing business as
CENTRAL CITY HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 1, 2024
Last certification
May 1, 2024
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
1240 3Rd St
Detroit, MI 48226-2505

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

130 E Grand Blvd
Detroit, MI 48207
Phone (313) 824-8224

2700 Martin Luther King Jr Blvd
Ste 11401
Detroit, MI 48208

8333 Townsend St
Detroit, MI 48213
Phone (313) 579-5824

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Barbara Hubbard-Frazier Individual Corporate Officer Dec 1, 2023
Derrell Grant Individual Corporate Officer Dec 1, 2023
Detroit Central City Community Mental Health Inc Organization, Detroit, MI Corporation, Non-profit Operational/Managerial Control Dec 1, 2023 100%
Nicole Freeman-Kirkland Individual Corporate Officer Dec 1, 2023
Daniel D Spyker Individual Corporate Officer Dec 1, 2023
Kimberly M Farrow Individual Corporate DirectorCeo Dec 1, 2023 100%
W-2 Managing EmployeeAd;President & Ceo Dec 1, 2023 100%
Operational/Managerial ControlPresident & Chief Executive Officer Dec 1, 2023 100%
Wilhelmenia Jones Individual Corporate Officer Dec 1, 2023

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 37

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 37

NPI Registry JSON

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

{
    "created_epoch": "1407888000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720656000000",
    "number": "1285043406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 PETERBORO ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482012722",
            "telephone_number": "313-831-3160",
            "fax_number": "313-826-0567"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 PETERBORO ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482012722",
            "telephone_number": "313-831-3160",
            "fax_number": "313-833-2604"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "14751 Mansfield St",
            "address_purpose": "LOCATION",
            "city": "Detroit",
            "state": "MI",
            "postal_code": "482271801",
            "country_code": "US",
            "telephone_number": "313-831-3160",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "130 E Grand Blvd",
            "address_purpose": "LOCATION",
            "city": "Detroit",
            "state": "MI",
            "postal_code": "482073713",
            "country_code": "US",
            "telephone_number": "313-831-3160",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8333 Townsend St",
            "address_purpose": "LOCATION",
            "city": "Detroit",
            "state": "MI",
            "postal_code": "482132331",
            "country_code": "US",
            "telephone_number": "313-831-3160",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2700 Martin Luther King Jr Blvd Ste 11401",
            "address_purpose": "LOCATION",
            "city": "Detroit",
            "state": "MI",
            "postal_code": "482082576",
            "country_code": "US",
            "telephone_number": "313-831-3160",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4777 E Outer Dr",
            "address_purpose": "LOCATION",
            "city": "Detroit",
            "state": "MI",
            "postal_code": "482343241",
            "country_code": "US",
            "telephone_number": "313-831-3160",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1240 3rd St",
            "address_purpose": "LOCATION",
            "city": "Detroit",
            "state": "MI",
            "postal_code": "482262505",
            "country_code": "US",
            "telephone_number": "313-831-3160",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "DETROIT CENTRAL CITY COMMUNITY MENTAL HEALTH INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-13",
        "last_updated": "2024-07-11",
        "certification_date": "2024-07-11",
        "status": "A",
        "authorized_official_last_name": "RILEY",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "313-221-8595"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "MI",
            "license": "702008",
            "primary": true
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1285043406",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Central City Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Central City Integrated Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Detroit, MI

Sources for this page

Verify at the official NPI Registry.