Healthcare Provider Details

I. General information

NPI: 1326763079
Provider Name (Legal Business Name): PACKARD HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2022
Last Update Date: 10/05/2022
Certification Date: 10/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 ARNET ST STE 110
YPSILANTI MI
48198-5753
US

IV. Provider business mailing address

5200 VENTURE DR
ANN ARBOR MI
48108-9561
US

V. Phone/Fax

Practice location:
  • Phone: 734-985-7200
  • Fax: 734-484-0913
Mailing address:
  • Phone: 734-773-1829
  • 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: TODD R MONTRIEF
Title or Position: CFO
Credential: CPA
Phone: 734-926-4935