Healthcare Provider Details

I. General information

NPI: 1174642672
Provider Name (Legal Business Name): SAINT JOSEPH MERCY LIVINGSTON HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7960 W. GRAND RIVER SUITE 110
BRIGHTON MI
48116-6541
US

IV. Provider business mailing address

5301 E HURON RIVER DR PO BOX 993, MC 69504
YPSILANTI MI
48197-1051
US

V. Phone/Fax

Practice location:
  • Phone: 810-227-0404
  • Fax:
Mailing address:
  • Phone: 734-712-3456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: GARRY FAJA
Title or Position: PRESIDENT CEO
Credential:
Phone: 734-712-3791