Provider Demographics
NPI:1053705269
Name:WESTERN WAYNE FAMILY HEALTH CENTERS
Entity type:Organization
Organization Name:WESTERN WAYNE FAMILY HEALTH CENTERS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:R
Authorized Official - Last Name:ATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:734-941-4991
Mailing Address - Street 1:26650 EUREKA RD
Mailing Address - Street 2:SUITE C-1
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-4835
Mailing Address - Country:US
Mailing Address - Phone:734-941-4991
Mailing Address - Fax:734-941-4919
Practice Address - Street 1:25650 OUTER DR
Practice Address - Street 2:
Practice Address - City:LINCOLN PARK
Practice Address - State:MI
Practice Address - Zip Code:48146-2096
Practice Address - Country:US
Practice Address - Phone:313-383-1897
Practice Address - Fax:313-383-6018
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WESTERN WAYNE FAMILY HEALTH CENTERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-03-25
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty