Provider Demographics
NPI:1538122452
Name:HENRY FORD VILLAGE, INC.
Entity Type:Organization
Organization Name:HENRY FORD VILLAGE, INC.
Other - Org Name:HENRY FORD VILLAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRPERSON
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:JESMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-584-1000
Mailing Address - Street 1:15051 FORD RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-4698
Mailing Address - Country:US
Mailing Address - Phone:313-846-7142
Mailing Address - Fax:
Practice Address - Street 1:15051 FORD RD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-4698
Practice Address - Country:US
Practice Address - Phone:313-846-7142
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-11
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI824026314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI23-5593Medicare Oscar/Certification