Provider Demographics
NPI:1780856179
Name:ST. JOSEPH MERCY HOSPITAL
Entity Type:Organization
Organization Name:ST. JOSEPH MERCY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COORDINATOR, ADOLESCENT PARTIAL PRO
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:STEVEN
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:734-712-5750
Mailing Address - Street 1:7540 KENSINGTON DRIVE
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-3173
Mailing Address - Country:US
Mailing Address - Phone:517-414-7723
Mailing Address - Fax:
Practice Address - Street 1:5401 MCAULEY DR
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1011
Practice Address - Country:US
Practice Address - Phone:734-712-3457
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-26
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801061308283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital