Healthcare Provider Details

I. General information

NPI: 1700831500
Provider Name (Legal Business Name): HENRY FORD HEALTH ST. JOHN HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 FORD PL STE 3A
DETROIT MI
48202-3450
US

IV. Provider business mailing address

PO BOX 670884
DETROIT MI
48267-0884
US

V. Phone/Fax

Practice location:
  • Phone: 248-680-8000
  • Fax:
Mailing address:
  • Phone: 800-999-5829
  • Fax: 248-641-4840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number StateMI

VIII. Authorized Official

Name: KIMBERLY CEBALT
Title or Position: MANAGER PROVIDER AFFAIRS
Credential:
Phone: 313-874-6764