Provider Demographics
NPI: | 1235819285 |
---|---|
Name: | HENR Y FORD HEALTH SYSTEM |
Entity Type: | Organization |
Organization Name: | HENR Y FORD HEALTH SYSTEM |
Other - Org Name: | HENRY FORD HEALTH HEMOPHILIA TREATMENT CENTER |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | PROVIDER ENROLLMENT SUPERVISOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | KIMBERLY |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | CEBALT |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 313-874-6764 |
Mailing Address - Street 1: | 1 FORD PL STE 3A |
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: | 313-874-6764 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 2800 W GRAND BLVD |
Practice Address - Street 2: | |
Practice Address - City: | DETROIT |
Practice Address - State: | MI |
Practice Address - Zip Code: | 48202-2610 |
Practice Address - Country: | US |
Practice Address - Phone: | 313-725-7791 |
Practice Address - Fax: | 313-916-9047 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | HENR Y FORD HEALTH SYSTEM |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2023-07-24 |
Last Update Date: | 2023-07-31 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 282N00000X | Hospitals | General Acute Care Hospital |