Provider Demographics
NPI:1841223401
Name:HENRY FORD BEHAVIORAL HEALTH- WEST PARK CENTER
Entity Type:Organization
Organization Name:HENRY FORD BEHAVIORAL HEALTH- WEST PARK CENTER
Other - Org Name:HENRY FORD HEALTH SYSTEM
Other - Org Type:Other Name
Authorized Official - Title/Position:SR. V. P.
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:CONNELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-874-8714
Mailing Address - Street 1:5111 AUTO CLUB DR
Mailing Address - Street 2:SUITE 112
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-2749
Mailing Address - Country:US
Mailing Address - Phone:313-317-2000
Mailing Address - Fax:313-317-2090
Practice Address - Street 1:5111 AUTO CLUB DR
Practice Address - Street 2:SUITE 112
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-2749
Practice Address - Country:US
Practice Address - Phone:313-317-2000
Practice Address - Fax:313-317-2090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Not Answered261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Not Answered261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Not Answered261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder