NPIMap

Organization Active NPI

Detroit Central City Community Mental Health, Inc.

  • Federally Qualified Health Center (FQHC)
  • Detroit, MI
National Provider Identifier
1336995133
Registry record updated Sep 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
DETROIT CENTRAL CITY COMMUNITY MENTAL HEALTH, INC.
Practice address
1240 3Rd St
Detroit, MI 48226-2505
Phone
(313) 635-4213
NPI assigned
Apr 24, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 5, 2024

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

Authorized official

Name
Valencia A Frank, MBA, BS, RMA, SATS
Title
Revenue Cycle Manager
Phone
(313) 635-4213

Specialties & licenses 2

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

Addresses

Primary practice location

1240 3Rd St
Detroit, MI 48226-2505

Mailing address

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

Other names 1

  • Central City Health (Third Street) Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240501000222 MI Part A Provider - Federally Qualified Health Center (FQHC) 3274728829 2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Detroit, MI

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 2

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

National Provider Directory

National Provider Directory
Tax ID family
Detroit Central City Inc11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

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

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 2

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

NPI Registry JSON

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

{
    "created_epoch": "1713916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725494400000",
    "number": "1336995133",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1240 3RD ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482262505",
            "telephone_number": "313-635-4213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DETROIT CENTRAL CITY COMMUNITY MENTAL HEALTH, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-24",
        "last_updated": "2024-09-05",
        "certification_date": "2024-09-05",
        "status": "A",
        "authorized_official_last_name": "FRANK",
        "authorized_official_first_name": "VALENCIA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "REVENUE CYCLE MANAGER",
        "authorized_official_telephone_number": "313-635-4213",
        "authorized_official_credential": "MBA, BS, RMA, SATS"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Central City Health (Third Street)",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Detroit, MI

Sources for this page

Verify at the official NPI Registry.