Healthcare Provider Details

I. General information

NPI: 1992037634
Provider Name (Legal Business Name): HENRY FORD HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2010
Last Update Date: 02/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2799 WG BLVD
DETROIT MI
48202
US

IV. Provider business mailing address

826 EDISON ST
DETROIT MI
48202-1537
US

V. Phone/Fax

Practice location:
  • Phone: 313-916-2710
  • Fax:
Mailing address:
  • Phone: 313-869-2644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: MR. TIMOTHY LEROY HAYES
Title or Position: NURSE PRACTITIONER
Credential: FNP BC
Phone: 313-916-2710