Healthcare Provider Details

I. General information

NPI: 1437301405
Provider Name (Legal Business Name): BOTSFORD GENERAL HOSPTIAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2008
Last Update Date: 11/03/2020
Certification Date: 11/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28100 GRAND RIVER AVE SUITE 301
FARMINGTON HILLS MI
48336-5967
US

IV. Provider business mailing address

26901 BEAUMONT BLVD COMPLIANCE
SOUTHFIELD MI
48033-4716
US

V. Phone/Fax

Practice location:
  • Phone: 248-477-6100
  • Fax:
Mailing address:
  • Phone: 947-522-1963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: LESLEY WILLBRANDT
Title or Position: DIRECTOR SHARED SERVICES
Credential:
Phone: 947-522-1911