Healthcare Provider Details

I. General information

NPI: 1093737090
Provider Name (Legal Business Name): HENRY FORD BEHAVIORAL HEALTH- TROY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 03/08/2024
Certification Date: 03/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 LIVERNOIS RD
TROY MI
48083-1214
US

IV. Provider business mailing address

2825 LIVERNOIS RD
TROY MI
48083-1214
US

V. Phone/Fax

Practice location:
  • Phone: 248-682-2060
  • Fax: 248-680-2099
Mailing address:
  • Phone: 248-682-2060
  • Fax: 248-680-2099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROBIN DAMSCHRODER
Title or Position: EVP, CHIEF FINANCE
Credential:
Phone: 248-648-7204