1023107877 NPI number — HENRY FORD HEALTH SYSTEM

Table of content: (NPI 1023107877)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023107877 NPI number — HENRY FORD HEALTH SYSTEM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HENRY FORD HEALTH SYSTEM
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HENRY FORD REHABILITATION SERVICES, WARREN
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023107877
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 FORD PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DETROIT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48202-3450
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-498-4960
Provider Business Mailing Address Fax Number:
586-498-4936

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3601 E 11 MILE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WARREN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48092-2878
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-582-9626
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CONNELLY
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
313-876-8714

Provider Taxonomy Codes

  • Taxonomy code: 273Y00000X , with the licence number:  82-0040 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000001537 . This is a "E04 CAPE HEALTH" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 121143 . This is a "H50 PREFERRED CHOI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 266564000 . This is a "E20 COMM BEHAVIOR" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 40 5170433 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010900 . This is a "E21 CARELINK NETWO" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0726021 . This is a "H71 AETNA HMO" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 14599 . This is a "E22 PERSON CENTER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 383404533002 . This is a "G01 TRI-CARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 341420303 . This is a "J23 MEADOWBROOK" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 383404533002 . This is a "G02 CHAMPVA CENTER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 49882 . This is a "H45 OMNICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 55150 . This is a "H61 TOTAL HEALTH CAR" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 121143 . This is a "H08 CARE CHOICES HMO" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 369003700 . This is a "J52 US DEPT/LABOR" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 383404533002 . This is a "G03 TRICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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