PROVIDENCE HOSPITAL (NPI# 1881891372) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1881891372 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE HOSPITAL |
| Practice Address |
16400 N Park Dr Apt 1008 Southfield MI 48075-4728 |
| Mailing Address |
16400 N.park Drive Apt.1008 Southfield MI 48075 |
| Practice Telephone | 2488357259 |
| Mailing Telephone | 2488357259 |
| Enumeration Date | 2007-06-28 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | GARY G OTSUJI (PROGRAMDIRECTOR) |
| Authorized Official Telephone | 2488493447 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 281P00000X | Chronic Disease Hospital | Hospitals |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134584667 | Providence Hospital | Clinic/Center | 3413 Olive Branch Dr, Silver Spring, MD 20904-4973 | 2015-12-29 |
| 1548486681 | Providence Hospital | General Acute Care Hospital | 10508 Keane Dr, Grass Lake, MI 49240-8803 | 2007-04-17 |
| 1932277050 | Providence Hospital | Rehabilitation Hospital | 6351 Woodside Dr, Theodore, AL 36582-6061 | 2006-11-30 |
| 1861057416 | Providence Hospital | Clinic/Center | 1150 Varnum St Ne, Washington, DC 20017-2180 | 2019-05-08 |
| 1861954638 | Providence Hospital | Emergency Medicine | 1150 Varnum St Ne, Washington, DC 20017-2180 | 2019-04-02 |
| 1710362496 | Providence Hospital | General Acute Care Hospital | 16001 W 9 Mile Rd, Southfield, MI 48075-4818 | 2015-07-23 |
| 1871922971 | Providence Hospital | Hospitalist | 6801 Airport Blvd, Hospitalist Dept., Mobile, AL 36608-3709 | 2013-11-08 |
| 1992133912 | Providence Hospital | Anesthesiology | 6801 Airport Blvd, Anesthesia Dept., Mobile, AL 36608-3709 | 2013-10-30 |
| 1659707149 | Providence Hospital | General Acute Care Hospital | 1150 Varnum St Ne, Washington, DC 20017-2104 | 2013-09-17 |
| 1649616384 | Providence Hospital | General Acute Care Hospital | 1150 Varnum St Ne, Washington, DC 20017-2104 | 2013-05-21 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | PROVIDENCE HOSPITAL | 914 S Scheuber Rd, Centralia, WA 98531-9027 |
| System for Award Management (SAM) Entities | PROVIDENCE HOSPITAL AND MEDICAL CENTERS | 16001 W 9 Mile Rd, Southfield, MI 48075-4818 |
| Iowa Business Entities | PROVIDENCE HOSPITALITY PARTNERS LLC | 709 Clarkson St, Denver, CO 80218 |
| Colorado Business Entities | PROVIDENCE HOSPITALITY PARTNERS LLC | 1888 N Sherman St, Suite 610, Denver, CO 80203 |
| New York State Corporations | PROVIDENCE HOSPITALITY PARTNERS LLC | 1888 N Sherman St, Suite 610, Denver, Co 80203 |
| Street Address |
16400 N PARK DR APT 1008 |
| City | SOUTHFIELD |
| State | MI |
| Zip Code | 48075-4728 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851900054 | K&b Medical Wigs, LLC | Durable Medical Equipment & Medical Supplies | 16250 Northland Dr. Ste 221, Southfield, MI 48075 | 2020-07-24 |
| 1790300390 | Julian Jeberaeel | Radiology | 2250 Providence, Southfield, MI 48075 | 2020-06-10 |
| 1265056410 | Husein Yusuf Husein | Podiatrist | Ascension Providence Hospital Southfield Campus, 16001 W. Nine Mile Rd. Depaul 2nd Floor, Southfield, Mi, MI 48075 | 2020-06-03 |
| 1952945420 | Paris Straughter | Nurse Practitioner | 18438 Onyx St, Southfield, MI 48075 | 2019-10-29 |
| 1811467657 | Medicine Man Medical, Pllc | Physical Medicine & Rehabilitation | 25130 Southfield Road, Suite #210, Southfield, MI 48075 | 2018-12-04 |
| 1447725528 | Rommel Ramos Perez | Physical Therapist | 26017 Greenfield Rd., Southfield, MI 48075 | 2018-10-04 |
| 1073009627 | Jacqueline Venora Goodgame | Licensed Practical Nurse | 4000 Town Ctr, Southfield, MI 48075 | 2018-07-06 |
| 1043712532 | Hollie Marie Maltese | Physical Therapy Assistant | 22255 Greenfiled 118, Southfield, MI 48075 | 2018-03-01 |
| 1932601481 | Katie Marie Mccormack | Occupational Therapist | 16001 West Nine Mile Rd., Southfield, MI 48075 | 2018-03-01 |
| 1801304241 | Absolute Hc LLC | Physical Therapist | 23461 Greenfield Rd Ste 200b, Southfield, MI 48075 | 2018-01-19 |
| Find all providers in zip 48075 | ||||
| Taxonomy Code | 281P00000X |
| Grouping | Hospitals |
| Classification | Chronic Disease Hospital |
| (1) A hospital including a physical plant and personnel that provides multidisciplinary diagnosis and treatment for diseases that have one or more of the following characteristics: is permanent; leaves residual disability; is caused by nonreversible pathological alteration; requires special training of the patient for rehabilitation; and/or may be expected to require a long period of supervision or care. In addition, patients require the safety, security, and shelter of these specialized inpatient or partial hospitalization settings. (2) A hospital that provides medical and skilled nursing services to patients with long-term illnesses who are not in an acute phase but who require an intensity of services not available in nursing homes. |
| Notes: Source: (1) Expanded from Rhea, Ott, and Shafritz, The Facts On File Dictionary of Health Care Management, New York: Facts On File Publications, 1988. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811187149 | Rehab Medical Specialist | Chronic Disease Hospital | 24901 Northwestern Hwy Ste 205, Southfield, MI 48075-2205 | 2007-08-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962663195 | Rajiv Sharma | Chronic Disease Hospital | 3291 Shadydale Ln, West Bloomfield, MI 48323-1857 | 2008-06-20 |
| 1548451164 | Henry Ford Health-main Hospital | Chronic Disease Hospital | 2799 W Grand Blvd Ste E1635, Detroit, MI 48202-2608 | 2007-08-08 |
| 1710105572 | Mercy General Health Partners | Chronic Disease Hospital | 1700 Oak Ave Ste 007, Muskegon, MI 49442-2407 | 2007-04-24 |
| 1558398701 | Veteran Affairs Medical Center | Chronic Disease Hospital | 325 H East Street, Ironmountain, MI 49801-6657 | 2006-06-26 |
| 1235792367 | Nevin Brittain | Chronic Disease Hospital | 2092 Lac Du Mont Apt D-t, Haslett, MI 48840-9564 | 2019-04-15 |
| 1679978480 | Barbara Ann Karmanos | Chronic Disease Hospital | 4100 John R St, Detroit, MI 48201-2013 | 2014-10-23 |
| 1861747958 | Allegiance Health | Chronic Disease Hospital | 205 N East Ave, Jackson, MI 49201-1753 | 2012-07-16 |
| City | SOUTHFIELD |
| Zip Code | 48075 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.