NPIMap

Organization Active NPI

Detroit Health Care for the Homeless

Doing business as Advantage Health Centers

  • Federally Qualified Health Center (FQHC)
  • Detroit, MI
National Provider Identifier
1801361464
Registry record updated Jul 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
DETROIT HEALTH CARE FOR THE HOMELESS
Doing business as
Advantage Health Centers
Practice address
1355 Oakman Blvd
Detroit, MI 48238-2849
Phone
(313) 416-6262
NPI assigned
Oct 10, 2018
Last updated
Jul 18, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2024

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

Authorized official

Name
Nina Abubakari
Title
Ceo
Phone
(313) 416-6223

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

1355 Oakman Blvd
Detroit, MI 48238-2849

Mailing address

100 River Place Dr Ste 450
Detroit, MI 48207-5402
Phone (313) 416-6223

Other names 1

  • Advantage Health Centers Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040526000397 MI Part B Supplier - Clinic/Group Practice 2668368572 Receives reassigned benefits from 14 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Detroit, MI; Warren, MI
O20190206001835 MI Part A Provider - Federally Qualified Health Center (FQHC) 2668368572 Practice locations: Detroit, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1801361464. Details of each certification follow.

Federally qualified health center certification: CCN 231138

Legal name
DETROIT HEALTH CARE FOR THE HOMELESS
Doing business as
ADVANTAGE HEALTH CENTERS
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 5, 2019
Last certification
Feb 5, 2019
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 30, 1986 in MI
Enrollment address
1355 Oakman Blvd
Detroit, MI 48238-2849

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 8

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

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Stacie Durant Individual Corporate OfficerBoard Member Dec 1, 2017
Lowell Allen Fernander Individual Corporate OfficerBoard Member Jun 1, 2022
Imani Adegbuyi Individual Corporate OfficerBoard Member Jun 1, 2022
Lisa Berden Individual Corporate OfficerBoard Member Mar 1, 2021
Kimberly Gaedeke Individual Corporate OfficerBoard Member Mar 1, 2021
Nina Abubakari Individual Corporate OfficerCeo Jun 27, 2016 100%
W-2 Managing EmployeeCeo Jun 27, 2016 100%
Elizabeth Jakstys Individual Corporate OfficerBoard Member Jun 1, 2022
Eric Brown Individual Corporate OfficerSecretary Mar 1, 2020
Charles Felton Individual Corporate OfficerPresident Feb 1, 2018
Patricia Adams Individual Corporate OfficerBoard Member Feb 1, 2018
Stephen Ragan Individual Corporate OfficerVice Chair Jun 1, 2020

NPI Registry JSON

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

{
    "created_epoch": "1539129600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721260800000",
    "number": "1801361464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 RIVER PLACE DR STE 450",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482075402",
            "telephone_number": "313-416-6223",
            "fax_number": "313-221-8217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1355 OAKMAN BLVD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482382849",
            "telephone_number": "313-416-6262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DETROIT HEALTH CARE FOR THE HOMELESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-10",
        "last_updated": "2024-07-18",
        "certification_date": "2024-07-18",
        "status": "A",
        "authorized_official_last_name": "ABUBAKARI",
        "authorized_official_first_name": "NINA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "313-416-6223"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advantage Health Centers",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Advantage Health Centers",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Detroit, MI

Sources for this page

Verify at the official NPI Registry.