Healthcare Provider Details

I. General information

NPI: 1205538584
Provider Name (Legal Business Name): PACKARD HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 03/20/2023
Certification Date: 03/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2345 TYLER RD
YPSILANTI MI
48198-6176
US

IV. Provider business mailing address

5200 VENTURE DR
ANN ARBOR MI
48108-9561
US

V. Phone/Fax

Practice location:
  • Phone: 734-971-1073
  • Fax: 734-971-8545
Mailing address:
  • Phone: 734-971-1073
  • Fax: 734-773-1833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: RAYMOND JOHN RION
Title or Position: EXECUTIVE DIRECTOR
Credential: MD
Phone: 734-971-1073