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General NPI Number Information
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NPI Number | 1245896000
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Entity Type | Organization
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Legal Business Name | BOTSFORD GENERAL HOSPITAL
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Dates
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Enumeration Date | 05/16/2019
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Last Update Date | 05/16/2023
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Provider Practice Location Address
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Address Line | 26901 BEAUMONT BLVD. COMMUNITY HEALTH - D - 5
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City | SOUTHFIELD
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State | MI
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Zip | 48033
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Country | US
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Telephone | 947-522-1313
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Fax |
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Provider Business Mailing Address
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Address Line | 26901 BEAUMONT BLVD. COMPLIANCE
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City | SOUTHFIELD
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State | MI
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Zip | 48033-4617
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Country | US
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Telephone | 947-522-1963
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | NANCY SUSICK
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Credential |
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Telephone | 947-522-3338
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1800X
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Taxonomy Name | Corporate Health Clinic/Center
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License Number |
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License Number State |
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