Provider Demographics
NPI:1366552804
Name:AMERICAN INDIAN HEALTH AND FAMILY SERVICES OF SOUTHEASTERN MI INC
Entity type:Organization
Organization Name:AMERICAN INDIAN HEALTH AND FAMILY SERVICES OF SOUTHEASTERN MI INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:WANETA
Authorized Official - Middle Name:
Authorized Official - Last Name:ASSAF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-846-3718
Mailing Address - Street 1:PO BOX 810
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48121
Mailing Address - Country:US
Mailing Address - Phone:313-846-3718
Mailing Address - Fax:313-846-0150
Practice Address - Street 1:4880 LAWNDALESTREET
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48210
Practice Address - Country:US
Practice Address - Phone:313-846-3718
Practice Address - Fax:313-846-0150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0H21011OtherBCBSM PIN/FACILITY CODE
MI231034Medicare Oscar/Certification
MI0H21011OtherBCBSM PIN/FACILITY CODE