NPIMap

Organization Active NPI

Team Mental Health Services Inc.

Doing business as Team Wellness Center

  • Primary Care Clinic/Center
  • Detroit, MI
National Provider Identifier
1295324291
Registry record updated Jan 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
TEAM MENTAL HEALTH SERVICES INC.
Doing business as
Team Wellness Center
Practice address
3646 Mount Elliott St
Detroit, MI 48207-2311
Phone
(313) 626-2400
Fax
(313) 921-4125
NPI assigned
Jan 13, 2021
Last updated
Jan 30, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2023

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

Authorized official

Name
Antonio Pollicella
Title
Ceo
Phone
(313) 274-3700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X NU Primary

Addresses

Primary practice location

3646 Mount Elliott St
Detroit, MI 48207-2311

Mailing address

290 Town Center Dr Ste 400
Dearborn, MI 48126-2765
Phone (313) 274-3700

Other practice location 1

34290 Ford Rd
Westland, MI 48185-3051
Phone (734) 412-8800

Other practice location 2

14799 Dix Toledo Rd
Southgate, MI 48195-2507
Phone (734) 324-8326

Other names 1

  • Team Wellness Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081030000384 MI Part B Supplier - Clinic/Group Practice 2264451830 Receives reassigned benefits from 112 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Detroit, MI; Westland, MI; Southgate, MI

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Team Mental Health Services Inc8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

Locations

15000 Gratiot Ave
Detroit, MI 48205
Phone (313) 245-0600

2925 Russell St
Detroit, MI 48207
Phone (313) 462-4714

Practitioners & affiliated clinicians

Practitioners 102

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 102

NPI Registry JSON

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

{
    "created_epoch": "1610496000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675036800000",
    "number": "1295324291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "290 TOWN CENTER DR STE 400",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481262765",
            "telephone_number": "313-274-3700",
            "fax_number": "313-274-4900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3646 MOUNT ELLIOTT ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482072311",
            "telephone_number": "313-626-2400",
            "fax_number": "313-921-4125"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "34290 Ford Rd",
            "address_purpose": "LOCATION",
            "city": "Westland",
            "state": "MI",
            "postal_code": "481853051",
            "country_code": "US",
            "telephone_number": "734-412-8800",
            "fax_number": "313-274-4900",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "14799 Dix Toledo Rd",
            "address_purpose": "LOCATION",
            "city": "Southgate",
            "state": "MI",
            "postal_code": "481952507",
            "country_code": "US",
            "telephone_number": "734-324-8326",
            "fax_number": "734-221-0786",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "TEAM MENTAL HEALTH SERVICES INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-13",
        "last_updated": "2023-01-30",
        "certification_date": "2023-01-30",
        "status": "A",
        "authorized_official_last_name": "POLLICELLA",
        "authorized_official_first_name": "ANTONIO",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "313-274-3700"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Team Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Team Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Detroit, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.