Organization
HENRY FORD HEALTH ST. JOHN HOSPITAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CEBALT (DIRECTOR)
(313) 874-6764
Entity
Organization
Contact information
Practice address
22101 MOROSS RD, SUITE 101, DETROIT, MI 48236-2148
(586) 753-0011
Mailing address
28000 DEQUINDRE RD, WARREN, MI 48092-2468
(586) 753-0011
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0H26493
BCBSM PIN
MI
Enumeration date
03/08/2007
Last updated
03/12/2026
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