Healthcare Provider Details

I. General information

NPI: 1447453949
Provider Name (Legal Business Name): SINAI GRACE HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6071 W OUTER DR
DETROIT MI
48235-2624
US

IV. Provider business mailing address

6071 W OUTER DR
DETROIT MI
48235-2624
US

V. Phone/Fax

Practice location:
  • Phone: 313-966-2026
  • Fax: 313-578-3964
Mailing address:
  • Phone: 313-966-2026
  • Fax: 313-578-3964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. WILLIAM LUBAWAY
Title or Position: VICE PRESIDENT FINANCE
Credential: VICE PRESIDENT
Phone: 313-966-2026