Detroit Wayne County Health Authority
Organization Active NPI Primary Care Clinic/Center · Detroit, MI
NPI 1962733089 · NPPES record last updated May 19, 2026
Key facts
- NPI
- 1962733089
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Primary Care Clinic/Center 261QP2300X
- Legal business name
- DETROIT WAYNE COUNTY HEALTH AUTHORITY
- Practice address
- 10809 Mack Ave
Detroit, MI 48214-2119 - Phone
- (313) 824-1000
- Fax
- (313) 824-9000
- NPI assigned
- Jan 29, 2010
- Organization subpart
- No
Authorized official
- Name
- Mrs. Loretta Bush
- Title
- Ceo
- Phone
- (313) 871-3751
Other NPIs on the same Medicare enrollment 1
Other NPIs with the same Medicare PAC ID 3
Practitioners 63
-
Tiwanna Jeaninne Williams, FNP-BC
-
Hassan Ali Saghir, M.D.
-
Kehinde A. Ayeni, MD
-
Quanta Dawn Duncan, RDN
-
Christina Ezell Kirkwood, APRN, FNP-BC
-
Ayesha M Taj, D.O.
-
Ryan Abboud, DO
-
Farhad Ali Amiri, DO
-
Mark Frederick Balino, D.O.
-
Wendy Joy Besler, MD
-
Emily Casterline, D.O.
-
Curtis Davis, D.O
-
Jonathan Mark Heckman, D.O.
-
Nicole E Jones, LLPC,CRC
-
Ashley Kaatz, DO
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MI
Federally qualified health center certification: CCN C71051
- Legal name
- DETROIT WAYNE COUNTY HEALTH AUTHORITY
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Dec 1, 2025
- Last certification
- Dec 1, 2025
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Enrollment address
- 10809 Mack Ave
Detroit, MI 48214-2119
All disclosed owners & managing parties 4
| Name | Role | Since | Share |
|---|---|---|---|
| Jaye Clement |
Corporate Officer |
Aug 14, 2024 | |
| Denise Brooks Williams |
Corporate Officer |
Jan 1, 2025 | |
| Loretta V Bush |
Corporate Officer |
May 19, 2019 | |
| W-2 Managing Employee |
May 1, 2019 | ||
| Corliss Beard |
Corporate Officer |
May 15, 2024 | |
| W-2 Managing Employee |
May 15, 2024 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20190219003271 | MI | Part B Supplier - Clinic/Group Practice | 4385982271 |
Receives reassigned benefits from 8 practitioners Practice locations: Detroit, MI; Southfield, MI |
| O20251203001765 | MI | Part a Provider - Federally Qualified Health Center (FQHC) | 4385982271 |
1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Detroit, MI |
National Provider Directory
Locations
3031 W Grand Blvd
Ste 450
Detroit, MI 48202
Phone (313) 346-5235
23077 Greenfield Rd
Southfield, MI 48075
Phone (248) 557-4129
27777 Lahser Rd
Southfield, MI 48034
Phone 3138241000 ext. 4
27777 Lahser Rd
Ste 200
Southfield, MI 48034
Phone (313) 824-1000
Interoperability endpoints
- https://api.platform.athenahealth.com/19827/brand/1/csg/1/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Public Health or Welfare Agency | 251K00000X | 251K00000X | ||
| Community/Behavioral Health Agency | 251S00000X | |||
| Clinic/Center | 261Q00000X | |||
| Community Health Clinic/Center | 261QC1500X | |||
| Health Service Clinic/Center | 261QH0100X | |||
| Adolescent and Children Mental Health Clinic/Center | 261QM0855X | |||
| Primary Care Clinic/Center | 261QP2300X | Yes | ||
| Clinic Pharmacy | 3336C0002X |
Addresses
Primary practice location
10809 Mack Ave
Detroit, MI 48214-2119
Mailing address
3031 W Grand Blvd
Detroit, MI 48202-3046
Phone (313) 824-1000
Other practice location 1
12121 Broadstreet Ave
Detroit, MI 48204-1550
Phone (313) 824-1000
Other practice location 2
23077 Greenfield Rd
Southfield, MI 48075-3709
Phone (313) 824-1000
Other practice location 3
27777 Lahser Rd Ste 200
Southfield, MI 48034-4751
Phone (313) 824-1000
Other providers in Detroit, MI
- Detroit Vamc
- Detroit Wayne County Community Mental Health Agency
- Detroit Wayne County Community Mental Health Agency
- Detroit Wayne County Health Authority
- Detroit Wayne County Health Authority
- Detroit Wayne Integrated Health Network
- Detroit Wayne Mental Health Authority
- Detroit Wayne Mental Health Authority
- Detroit Wayne Mental Health Authority
- Detroit-Macomb Hospital Corporation
All providers in Detroit, MI · Primary Care Clinic/Center in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 19, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.