Provider Demographics
NPI:1083809297
Name:HENRY FORD HEALTH SYSTEM
Entity Type:Organization
Organization Name:HENRY FORD HEALTH SYSTEM
Other - Org Name:CENTER FOR SENIOR INDEPENDENCE
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-653-2222
Mailing Address - Street 1:7800 W OUTER DR
Mailing Address - Street 2:STE.240
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235-3461
Mailing Address - Country:US
Mailing Address - Phone:313-653-2020
Mailing Address - Fax:313-653-2779
Practice Address - Street 1:7800 W OUTER DR
Practice Address - Street 2:STE.240
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-3461
Practice Address - Country:US
Practice Address - Phone:313-653-2020
Practice Address - Fax:313-653-2779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-11
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIH2318251T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4070184Medicaid
MIH2318OtherMEDICARE CONTRACT #/HIC#