# W.A. FOOTE MEMORIAL HOSPITAL, INC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** WA FOOTE MEMORIAL HOSPITAL, INC
- **Other names:** Henry Ford Jackson Health, Henry Ford Allegiance Health
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1629000708
- **Legal business name:** WA FOOTE MEMORIAL HOSPITAL, INC
- **Authorized official:** KIMBERLY CEBALT (DIRECTOR)
- **Authorized official phone:** (313) 874-6764

## Contact information

- **Practice address:** 205 N EAST AVE, JACKSON, MI 49201-1753
- **Practice address phone:** (517) 788-4800
- **Mailing address:** PO BOX 670884, DETROIT, MI 48267-2728
- **Mailing address phone:** (800) 999-5829

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | — | NULL | Yes |
| 363L00000X | Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 07/07/2006
- **Last updated:** 10/09/2026

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 500C810570 | BCBSM CNP | MI |
| 01 | — | CC5829 | RR MEDICARE | MI |