Healthcare Provider Details

I. General information

NPI: 1255629838
Provider Name (Legal Business Name): HENRY FORD HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2011
Last Update Date: 07/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5777 W MAPLE RD
WEST BLOOMFIELD MI
48322-2267
US

IV. Provider business mailing address

2799 W GRAND BLVD
DETROIT MI
48202-2608
US

V. Phone/Fax

Practice location:
  • Phone: 248-325-1000
  • Fax:
Mailing address:
  • Phone: 248-910-6400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number4704216583
License Number StateMI

VIII. Authorized Official

Name: MS. QUANTRESSA EDWARDS
Title or Position: MEDICAL STAFF COORDINATOR
Credential:
Phone: 313-874-3081