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Organization
W. A. FOOTE MEMORIAL HOSPITAL, INC.
Active
Organization
W. A. FOOTE MEMORIAL HOSPITAL, INC.
Active
Other names
Henry Ford Jackson Hospital, Allegiance Health
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CEBALT (DIRECTOR)
(313) 874-6764
Entity
Organization
Contact information
Practice address
205 N EAST AVE, JACKSON, MI 49201-1753
(517) 788-4800
Mailing address
PO BOX 670884, DETROIT, MI 48267-2728
(800) 999-5829
(313) 876-1305
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
MI
103T00000X
Psychologist
—
—
104100000X
Social Worker
—
—
2084N0400X
Neurology Physician
—
—
2084P0800X
Psychiatry Physician
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
260C863890
BCBSM
—
01
—
680C810300
BCBSM
MI
01
—
750910501
BCBSM
MI
01
—
800C810270
BCBSM
MI
01
—
CC5829
RR MEDICARE
MI
Enumeration date
07/03/2006
Last updated
04/07/2026
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