Provider Demographics
NPI:1679571392
Name:DOWNRIVER COMMUNITY SERVICES, INC.
Entity type:Organization
Organization Name:DOWNRIVER COMMUNITY SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-749-5197
Mailing Address - Street 1:PO BOX 480430
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:48048
Mailing Address - Country:US
Mailing Address - Phone:586-749-5197
Mailing Address - Fax:586-749-5560
Practice Address - Street 1:58144 GRATIOT AVENUE
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:MI
Practice Address - Zip Code:48048
Practice Address - Country:US
Practice Address - Phone:586-749-5197
Practice Address - Fax:586-749-5560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-08
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI231821Medicare Oscar/Certification
MI0E06335Medicare PIN