Healthcare Provider Details

I. General information

NPI: 1104010578
Provider Name (Legal Business Name): HENRY FORD HEALTH SYSTEM-SCHOOL BASED HEALTH INITIATIVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2007
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13322 CONANT AVE HFHS CLEVELAND HEALTH CENTER
DETROIT MI
48212
US

IV. Provider business mailing address

ONE FORD PLACE STE 4B HFHS SBCHP
DETROIT MI
48202
US

V. Phone/Fax

Practice location:
  • Phone: 313-366-9050
  • Fax: 313-366-3809
Mailing address:
  • Phone: 313-874-5426
  • Fax: 313-874-9169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301044212
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. KELLY RATOWSKI
Title or Position: DIRECTOR OF PROVIDER AFFAIRS
Credential: MHSA
Phone: 313-874-4806