Provider Demographics
NPI:1053480905
Name:STATE OF MICHIGAN
Entity Type:Organization
Organization Name:STATE OF MICHIGAN
Other - Org Name:HAWTHORN CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HOSPITAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY CLARE
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-367-8601
Mailing Address - Street 1:30901 PALMER ROAD
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48186-5389
Mailing Address - Country:US
Mailing Address - Phone:734-367-8400
Mailing Address - Fax:248-349-9552
Practice Address - Street 1:30901 PALMER ROAD
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48186-5389
Practice Address - Country:US
Practice Address - Phone:734-367-8400
Practice Address - Fax:248-349-9552
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WALTER REUTHER PSYCHIATRIC HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-07
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
283Q00000X, 333600000X
MI53010007603336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1758890Medicaid
2040978OtherPK