Healthcare Provider Details

I. General information

NPI: 1053480905
Provider Name (Legal Business Name): STATE OF MICHIGAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 09/12/2024
Certification Date: 07/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30901 PALMER ROAD
WESTLAND MI
48186-5389
US

IV. Provider business mailing address

30901 PALMER ROAD
WESTLAND MI
48186-5389
US

V. Phone/Fax

Practice location:
  • Phone: 734-367-8600
  • Fax: 248-349-9552
Mailing address:
  • Phone: 734-367-8600
  • Fax: 248-349-9552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number5301000760
License Number StateMI

VIII. Authorized Official

Name: MARY CLARE SOLKY
Title or Position: HOSPITAL DIRECTOR
Credential: MA
Phone: 734-367-8401