Provider Demographics
NPI:1114009032
Name:HENRY FORD HEALTH SYSTEM
Entity Type:Organization
Organization Name:HENRY FORD HEALTH SYSTEM
Other - Org Name:HENRY FORD COTTAGE HOSPITAL (PSYCH)
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:2006-10-19
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIH-630001273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI000000001537OtherE04 CAPR HEALTH
MI010900OtherE21 CARELINK NETWO
MI121143OtherH08 CARE CHOICES HMO
MI383404533002OtherG03 TRICARE
MI73 1557865Medicaid
MI0726021OtherH71 AETNA HMO
MI121143OtherH50 PREFERRED CHOI
MI383404533002OtherG01 TRI-CARE
MI383404533002OtherG02 CHAMPVA CENTER
MI49882OtherH45 OMNICARE
MI341420303OtherJ23 MEADOWBROOK
MI200OtherOTHER: BCBSM
MI55150OtherH61 TOTAL HLTH CAR
MI266564000OtherE20 COMM BEHAVIOR
MI369003700OtherJ52 US DEPT/LABOR
MI14599OtherE22 PERSON CENTER
MI23-S135Medicare ID - Type UnspecifiedMEDICARE