Provider Demographics
NPI:1457609414
Name:HENRY FORD HEALTH SYSTEM
Entity Type:Organization
Organization Name:HENRY FORD HEALTH SYSTEM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUTE CARE NURSE PRACTITIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:PHILLIP
Authorized Official - Last Name:MORGANROTH
Authorized Official - Suffix:
Authorized Official - Credentials:ACNP
Authorized Official - Phone:586-405-7211
Mailing Address - Street 1:13709 MELVA DR
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48088-6060
Mailing Address - Country:US
Mailing Address - Phone:586-405-7211
Mailing Address - Fax:
Practice Address - Street 1:2799 W GRAND BLVD
Practice Address - Street 2:CLARA FORD PAVILION ROOM 126
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2608
Practice Address - Country:US
Practice Address - Phone:313-916-7036
Practice Address - Fax:313-916-8007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-23
Last Update Date:2012-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704242767282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access