Organization
DETROIT MEDICAL CENTER
Active
Parent organization
TENENT
Other names
Children's Hospital of MI
Organization subpart
Yes
Provider details
NPI number
Legal business name
TENENT
Authorized official
MS. TRACEY ALLENE TYUS-BAILEY LMSW (CLINICAL SOCIAL WORKER)
(313) 745-5281
Entity
Organization
Contact information
Practice address
43205 CREEKVIEW DR, CANTON, MI 48187-3049
(734) 844-7241
Mailing address
43205 CREEKVIEW DR, CANTON, MI 48187-3049
(734) 844-7241
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
6801067466
MI
282N00000X
General Acute Care Hospital
6801067466
MI
282NC2000X
Children's Hospital
Primary
6801067466
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6801067466
MICHIGAN LICENSE NUMBER
MI
Enumeration date
12/19/2015
Last updated
12/19/2015
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