Provider Demographics
NPI:1104010578
Name:HENRY FORD HEALTH SYSTEM-SCHOOL BASED HEALTH INITIATIVE
Entity Type:Organization
Organization Name:HENRY FORD HEALTH SYSTEM-SCHOOL BASED HEALTH INITIATIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PROVIDER AFFAIRS
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:RATOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MHSA
Authorized Official - Phone:248-703-2003
Mailing Address - Street 1:ONE FORD PLACE
Mailing Address - Street 2:STE 4B HFHS SBCHP
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202
Mailing Address - Country:US
Mailing Address - Phone:313-874-5426
Mailing Address - Fax:313-874-9169
Practice Address - Street 1:13322 CONANT AVE
Practice Address - Street 2:HFHS CLEVELAND HEALTH CENTER
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48212
Practice Address - Country:US
Practice Address - Phone:313-366-9050
Practice Address - Fax:313-366-3809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X, 363A00000X, 363LP0808X
MI4301044212208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty