Active NPI
Fairsky Foundation
- Multi-Specialty Clinic/Center
- Ferndale, MI
National Provider Identifier
1033595665
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Multi-Specialty Clinic/Center
- Legal business name
- FAIRSKY FOUNDATION
- Practice address
- 23231 Woodward Ave
Ferndale, MI 48220-1361 - Phone
- (248) 581-8777
- Fax
- (888) 975-9374
- NPI assigned
- Aug 5, 2015
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. David St. John, PHD
- Title
- Executive Director
- Phone
- (248) 581-8777
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | |||
| Clinical Psychologist | 103TC0700X | |||
| Clinical Social Worker | 1041C0700X | |||
| Mental Health Clinic/Center (Including Community Mental Health Center) | 261QM0801X | |||
| Multi-Specialty Clinic/Center | 261QM1300X | Primary |
Addresses
Primary practice location
23231 Woodward Ave
Ferndale, MI 48220-1361
Mailing address
23231 Woodward Ave
Ferndale, MI 48220-1361
Phone (248) 581-8777
Other practice location 1
124 Pearl St Ste 303
Ypsilanti, MI 48197-2663
Phone (248) 581-8777
Other practice location 2
464 N Main St
Plymouth, MI 48170-1347
Phone (248) 581-8777
Other practice location 3
2020 Raybrook St SE Ste 203
Grand Rapids, MI 49546-7717
Phone (248) 581-8777
Other practice location 4
1300 Broadway St Ste 400
Detroit, MI 48226-2202
Phone (248) 581-8777
Other practice location 5
230 Collingwood St Ste 250
Ann Arbor, MI 48103-3845
Phone (248) 581-8777
Other practice location 6
1367 Andrews Ave Lowr
Lakewood, OH 44107-2405
Phone (248) 581-8777
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| CV0058149 | Medicaid | MI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20160720000492 | MI | Part B Supplier - Clinic/Group Practice | 2769775386 |
Receives reassigned benefits from 16 practitioners Practice locations: Detroit, MI; Ferndale, MI; Grand Rapids, MI; Plymouth, MI; Ypsilanti, MI |
National Provider Directory
National Provider DirectoryLocations
230 Collingwood St
Ste 250
Ann Arbor, MI 48103
Phone (248) 325-8199
1126 S Main St
Plymouth, MI 48170
Phone (248) 838-9220
124 Pearl St
Ste 303
Ypsilanti, MI 48197
Phone (248) 957-1148
Practitioners & affiliated clinicians
Practitioners 92
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1438732800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1661212800000",
"number": "1033595665",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "23231 WOODWARD AVE",
"city": "FERNDALE",
"state": "MI",
"postal_code": "482201361",
"telephone_number": "248-581-8777",
"fax_number": "888-975-9374"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "23231 WOODWARD AVE",
"city": "FERNDALE",
"state": "MI",
"postal_code": "482201361",
"telephone_number": "248-581-8777",
"fax_number": "888-975-9374"
}
],
"practiceLocations": [
{
"address_1": "124 Pearl St Ste 303",
"address_purpose": "LOCATION",
"city": "Ypsilanti",
"state": "MI",
"postal_code": "481972663",
"country_code": "US",
"telephone_number": "248-581-8777",
"fax_number": "888-975-9374",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "464 N Main St",
"address_purpose": "LOCATION",
"city": "Plymouth",
"state": "MI",
"postal_code": "481701347",
"country_code": "US",
"telephone_number": "248-581-8777",
"fax_number": "888-975-9374",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "2020 Raybrook St SE Ste 203",
"address_purpose": "LOCATION",
"city": "Grand Rapids",
"state": "MI",
"postal_code": "495467717",
"country_code": "US",
"telephone_number": "248-581-8777",
"fax_number": "888-975-9374",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1300 Broadway St Ste 400",
"address_purpose": "LOCATION",
"city": "Detroit",
"state": "MI",
"postal_code": "482262202",
"country_code": "US",
"telephone_number": "248-581-8777",
"fax_number": "888-975-9374",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "230 Collingwood St Ste 250",
"address_purpose": "LOCATION",
"city": "Ann Arbor",
"state": "MI",
"postal_code": "481033845",
"country_code": "US",
"telephone_number": "248-581-8777",
"fax_number": "888-975-9374",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1367 Andrews Ave Lowr",
"address_purpose": "LOCATION",
"city": "Lakewood",
"state": "OH",
"postal_code": "441072405",
"country_code": "US",
"telephone_number": "248-581-8777",
"fax_number": "888-975-9374",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"organization_name": "FAIRSKY FOUNDATION",
"organizational_subpart": "NO",
"enumeration_date": "2015-08-05",
"last_updated": "2022-08-23",
"certification_date": "2022-08-23",
"status": "A",
"authorized_official_last_name": "ST. JOHN",
"authorized_official_first_name": "DAVID",
"authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
"authorized_official_telephone_number": "248-581-8777",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "PHD"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Counselor, Professional",
"state": null,
"license": null,
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Psychologist, Clinical",
"state": null,
"license": null,
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Social Worker, Clinical",
"state": null,
"license": null,
"primary": false
},
{
"code": "261QM0801X",
"taxonomy_group": "",
"desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
"state": null,
"license": null,
"primary": false
},
{
"code": "261QM1300X",
"taxonomy_group": "",
"desc": "Clinic/Center, Multi-Specialty",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "CV0058149",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ferndale, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.