NPIMap

Organization Active NPI

St John Providence Eastwood Clinic

  • Clinic/Center
  • Detroit, MI
National Provider Identifier
1558619510
Registry record updated Aug 23, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
ST JOHN PROVIDENCE EASTWOOD CLINIC
Practice address
4777 E Outer Dr Ste 1105
Detroit, MI 48234-3241
Phone
(313) 369-5508
NPI assigned
Aug 23, 2012
Last updated
Aug 23, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2012

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

Authorized official

Name
Donald Healy, LMSW, CAADC, ACSW
Title
Supervisor
Phone
(313) 369-5508

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

4777 E Outer Dr Ste 1105
Detroit, MI 48234-3241

Mailing address

4777 E Outer Dr Ste 1105
Detroit, MI 48234-3241

National Provider Directory

National Provider Directory
Tax ID family
Eastwood Administrative23 organizations share this tax ID, including this one

Other organizations with this tax ID 22

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

View all 22

Locations

4777 E Outer Dr
Ste 1105
Detroit, MI 48234
Phone (313) 369-5508

NPI Registry JSON

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

{
    "created_epoch": "1345680000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1345680000000",
    "number": "1558619510",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4777 E OUTER DR STE 1105",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482343241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4777 E OUTER DR STE 1105",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482343241",
            "telephone_number": "313-369-5508"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST JOHN PROVIDENCE EASTWOOD CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-23",
        "last_updated": "2012-08-23",
        "status": "A",
        "authorized_official_last_name": "HEALY",
        "authorized_official_first_name": "DONALD",
        "authorized_official_title_or_position": "SUPERVISOR",
        "authorized_official_telephone_number": "313-369-5508",
        "authorized_official_credential": "LMSW, CAADC, ACSW"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Aug 23, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.