Provider Demographics
NPI:1891075958
Name:HENRY FORD HEALTH SYSTEM
Entity Type:Organization
Organization Name:HENRY FORD HEALTH SYSTEM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIORAL HEALTH THERAPIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:M
Authorized Official - Last Name:MALINOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MA LLP
Authorized Official - Phone:313-317-2000
Mailing Address - Street 1:5111 AUTO CLUB DR
Mailing Address - Street 2:SUITE 112 BLDIG 5
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 BLDIG 5
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:2011-08-22
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301007252261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health