Provider Demographics
NPI:1053386334
Name:HENRY FORD HEALTH SYSTEM
Entity type:Organization
Organization Name:HENRY FORD HEALTH SYSTEM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP COMMUNTIY CARE SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:POLANSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-642-1111
Mailing Address - Street 1:21651 MELROSE AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-7906
Mailing Address - Country:US
Mailing Address - Phone:248-353-2468
Mailing Address - Fax:248-353-4260
Practice Address - Street 1:2799 W GRAND BLVD
Practice Address - Street 2:WP-1102A
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2608
Practice Address - Country:US
Practice Address - Phone:313-916-2927
Practice Address - Fax:313-916-2923
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HENRY FORD HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-21
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI540H22198OtherBCBS OF MICHIGAN
MI4962619Medicaid
MI2333OtherHAP
MI4962619Medicaid