Healthcare Provider Details

I. General information

NPI: 1023751203
Provider Name (Legal Business Name): CHARLESBROOK PROTECTION SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2022
Last Update Date: 04/15/2022
Certification Date: 04/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1345 MONROE AVE NW STE 328
GRAND RAPIDS MI
49505-4673
US

IV. Provider business mailing address

8725 WOODLAND FRST SE
ALTO MI
49302-9308
US

V. Phone/Fax

Practice location:
  • Phone: 616-648-8747
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: BRIAN QUEEN
Title or Position: CHIEF MEDICAL OFFICER
Credential: MD
Phone: 734-365-4330