Healthcare Provider Details

I. General information

NPI: 1669493664
Provider Name (Legal Business Name): FOREST HEALTH MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 10/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 S PROSPECT ST
YPSILANTI MI
48198-7914
US

IV. Provider business mailing address

135 S PROSPECT ST
YPSILANTI MI
48198-7914
US

V. Phone/Fax

Practice location:
  • Phone: 734-547-4722
  • Fax: 734-547-1461
Mailing address:
  • Phone: 734-547-4721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number5301007213
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: EJ LEDESMA
Title or Position: PRESIDENT
Credential:
Phone: 734-547-1410