NPIMap

Organization Active NPI

Community Health and Social Services Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Detroit, MI
National Provider Identifier
1982694196
Registry record updated Nov 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COMMUNITY HEALTH AND SOCIAL SERVICES CENTER, INC
Practice address
5635 W Fort St
Detroit, MI 48209-3154
Phone
(313) 849-3920
Fax
(313) 849-0824
NPI assigned
Oct 27, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2022

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

Authorized official

Name
Felix Mario Valbuena Jr., MDNPI 1992795165
Title
Ceo
Phone
(313) 849-3920

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

5635 W Fort St
Detroit, MI 48209-3154

Mailing address

5635 W Fort St
Detroit, MI 48209-3154
Phone (313) 849-3920

Other identifiers 1

IdentifierTypeStateIssuer
080Q246390OtherMIBC/BS OF MICHIGAN

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100830000350 MI Part A Provider - Federally Qualified Health Center (FQHC) 0547171514 Practice locations: Detroit, MI
O20241019000170 MI Part B Supplier - Clinic/Group Practice 0547171514 Receives reassigned benefits from 2 practitioners
Practice locations: Detroit, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1982694196. Details of each certification follow.

Federally qualified health center certification: CCN 231849

Legal name
COMMUNITY HEALTH AND SOCIAL SERVICES CENTER, INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 19, 1994
Last certification
Sep 19, 1994
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
May 26, 1993 in MI
Enrollment address
5635W Fort St
Detroit, MI 48209-3154

Other NPIs with the same Medicare PAC ID 2

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

National Provider Directory

National Provider Directory
Tax ID family
Chass Mack9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Susan Hooksbrown Individual Corporate Director Dec 14, 2010
Felix M Valbuena Individual Corporate OfficerChief Executive Officer Jan 1, 2017 5%
W-2 Managing EmployeeChief Executive Officer Jan 1, 2017 5%
Operational/Managerial Control Jan 1, 2017
Michael Murray Individual Corporate Director Dec 14, 2010
Patrick Irwin Individual Corporate Director Jan 24, 2011
Lenetta Skinnerwalker Individual Corporate Director Dec 14, 2010

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 35

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 35

NPI Registry JSON

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

{
    "created_epoch": "1130371200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1668470400000",
    "number": "1982694196",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5635 W FORT ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482093154",
            "telephone_number": "313-849-3920",
            "fax_number": "313-849-0824"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5635 W FORT ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482093154",
            "telephone_number": "313-849-3920",
            "fax_number": "313-849-0824"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH AND SOCIAL SERVICES CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-27",
        "last_updated": "2022-11-15",
        "certification_date": "2022-11-15",
        "status": "A",
        "authorized_official_last_name": "VALBUENA",
        "authorized_official_first_name": "FELIX",
        "authorized_official_middle_name": "MARIO",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "313-849-3920",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS OF MICHIGAN",
            "identifier": "080Q246390",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit, MI

Sources for this page

Verify at the official NPI Registry.