Provider Demographics
NPI:1386068609
Name:HENRY FORD HEALTH SYSTEM
Entity type:Organization
Organization Name:HENRY FORD HEALTH SYSTEM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ATHLETIC TRAINER/ SPORTS MEDICINE
Authorized Official - Prefix:
Authorized Official - First Name:DAYNA
Authorized Official - Middle Name:NICHOLE
Authorized Official - Last Name:ELENIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-840-9710
Mailing Address - Street 1:1258 FRANKLIN RD
Mailing Address - Street 2:
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-2116
Mailing Address - Country:US
Mailing Address - Phone:248-840-9710
Mailing Address - Fax:
Practice Address - Street 1:1258 FRANKLIN RD
Practice Address - Street 2:
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072-2116
Practice Address - Country:US
Practice Address - Phone:248-840-9710
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-06
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2601000322283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital