NPIMap

Organization Active NPI

Northwest Industrial Drug Rehabilitation Clinic

  • Methadone Clinic
  • Detroit, MI
National Provider Identifier
1821112103
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Methadone ClinicTaxonomy code 261QM2800X
Legal business name
NORTHWEST INDUSTRIAL DRUG REHABILITATION CLINIC
Practice address
9600 Dexter Ave
Detroit, MI 48206-1816
Phone
(313) 894-6379
NPI assigned
Mar 19, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Carl Dennis Fowler, M.D.
Title
Owner President
Phone
(313) 894-4879

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Methadone Clinic 261QM2800X Primary

Addresses

Primary practice location

9600 Dexter Ave
Detroit, MI 48206-1816

Mailing address

9600 Dexter Ave
Detroit, MI 48206-1816

National Provider Directory

National Provider Directory
Tax ID family
Northwest Industrial Drug Rehabilitation Clinic3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

NPI Registry JSON

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

{
    "created_epoch": "1174262400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1821112103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9600 DEXTER AVE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482061816"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9600 DEXTER AVE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482061816",
            "telephone_number": "313-894-6379"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST INDUSTRIAL DRUG REHABILITATION CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FOWLER",
        "authorized_official_first_name": "CARL",
        "authorized_official_middle_name": "DENNIS",
        "authorized_official_title_or_position": "OWNER  PRESIDENT",
        "authorized_official_telephone_number": "313-894-4879",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "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 22, 2020; 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.