Provider Demographics
NPI:1003892092
Name:ASCENSION PROVIDENCE HOSPITAL
Entity Type:Organization
Organization Name:ASCENSION PROVIDENCE HOSPITAL
Other - Org Name:PROVIDENCE-PROVIDENCE PARK HOSPITAL
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:HURSHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:243-349-3400
Mailing Address - Street 1:16001 W 9 MILE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-4818
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16001 W. 9 MILE ROAD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4818
Practice Address - Country:US
Practice Address - Phone:243-349-3000
Practice Address - Fax:248-746-0384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-21
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes273R00000XHospital UnitsPsychiatric UnitGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI20277OtherBLUE CROSS
MI1557875Medicaid
MI21277OtherBLUE CROSS
MI20277OtherBLUE CROSS