Provider Demographics
NPI:1841687589
Name:PACKARD HEALTH, INC.
Entity type:Organization
Organization Name:PACKARD HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTRIEF
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:734-926-4935
Mailing Address - Street 1:5200 VENTURE DR
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-9561
Mailing Address - Country:US
Mailing Address - Phone:734-926-4935
Mailing Address - Fax:734-773-1833
Practice Address - Street 1:1915 PAULINE BLVD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-5001
Practice Address - Country:US
Practice Address - Phone:734-926-4900
Practice Address - Fax:734-926-4901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-21
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI231050Medicare Oscar/Certification