Healthcare Provider Details

I. General information

NPI: 1740446566
Provider Name (Legal Business Name): HENRY'S INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2008
Last Update Date: 07/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30935 PENNSYLVANIA RD
ROMULUS MI
48174-9215
US

IV. Provider business mailing address

29202 BRADMOOR CT
FARMINGTON HILLS MI
48334-3261
US

V. Phone/Fax

Practice location:
  • Phone: 734-941-5528
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License NumberAS820273992
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License NumberAS820273992
License Number StateMI

VIII. Authorized Official

Name: MR. MARSHALL HENRY JR.
Title or Position: PRESIDENT/PROVIDER
Credential:
Phone: 248-855-8471