Provider Demographics
NPI:1801034988
Name:HENRY FORD COTTAGE HOSPITAL
Entity Type:Organization
Organization Name:HENRY FORD COTTAGE HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:ARMADO
Authorized Official - Suffix:
Authorized Official - Credentials:CHE,
Authorized Official - Phone:313-916-8058
Mailing Address - Street 1:159 KERCHEVAL AVE
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-3610
Mailing Address - Country:US
Mailing Address - Phone:313-640-1000
Mailing Address - Fax:313-343-8641
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:313-343-8641
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HENRY FORD HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-28
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI820040273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1609962059Medicaid