Provider Demographics
NPI:1033294087
Name:HENRY FORD HEALTH SYSTEM
Entity Type:Organization
Organization Name:HENRY FORD HEALTH SYSTEM
Other - Org Name:HENRY FORD COTTAGE HOSPITAL (REHAB)
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:CONNELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-876-8714
Mailing Address - Street 1:1 FORD PL
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-3450
Mailing Address - Country:US
Mailing Address - Phone:586-498-4960
Mailing Address - Fax:586-498-4936
Practice Address - Street 1:159 KERCHEVAL AVE
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE FARMS
Practice Address - State:MI
Practice Address - Zip Code:48236-3610
Practice Address - Country:US
Practice Address - Phone:313-640-1000
Practice Address - Fax:313-884-8927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI82-0040273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI000000001537OtherE04 CAPE HEALTH
MI14599OtherE22 PERSON CENTER
MI383404533002OtherG03 TRICARE
MI383404533002OtherG02 CHAMPVA CENTER
MI200OtherOTHER: BCBSM
MI30 2774932Medicaid
MI341420303OtherJ23 MEADOWBROOK
MI55150OtherH61 TOTAL HLTH CAR
MI010900OtherE21 CARELINK NETWO
MI266564000OtherE20 COMM BEHAVIOR
MI369003700OtherJ52 US DEPT/LABOR
MI0726021OtherH71 AETNA HMO
MI49882OtherH45 OMNICARE
MI121143OtherH50 PREFERRED CHOI
MI121143OtherH08 CARE CHOICES HMO
MI383404533002OtherG01 TRI-CARE
MI383404533002OtherG01 TRI-CARE