Provider Demographics
NPI:1407889116
Name:HENRY FORD BEHAVIORAL HEALTH- WEST BLOOMFIELD
Entity Type:Organization
Organization Name:HENRY FORD BEHAVIORAL HEALTH- WEST BLOOMFIELD
Other - Org Name:HENRY FORD HEALTH SYSTEM
Other - Org Type:Other Name
Authorized Official - Title/Position:EVP, CHIEF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DAMSCHRODER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-648-7204
Mailing Address - Street 1:6777 W MAPLE RD
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3013
Mailing Address - Country:US
Mailing Address - Phone:248-661-7393
Mailing Address - Fax:248-661-7924
Practice Address - Street 1:6777 W MAPLE RD
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3013
Practice Address - Country:US
Practice Address - Phone:248-661-7393
Practice Address - Fax:248-661-7924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X
MI261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health