Healthcare Provider Details

I. General information

NPI: 1871662791
Provider Name (Legal Business Name): VILLAGE OF GROSSE POINTE SHORES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 12/14/2022
Certification Date: 12/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

795 LAKE SHORE RD
GROSSE POINTE SHORES MI
48236-1455
US

IV. Provider business mailing address

795 LAKE SHORE RD
GROSSE POINTE SHORES MI
48236-1455
US

V. Phone/Fax

Practice location:
  • Phone: 313-881-5500
  • Fax: 313-640-1661
Mailing address:
  • Phone: 313-881-5500
  • Fax: 313-640-1661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code341600000X
TaxonomyAmbulance
License Number821012
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: KENNETH V WERENSKI
Title or Position: DIRECTOR OF DPS
Credential:
Phone: 313-881-5501