Healthcare Provider Details

I. General information

NPI: 1669524948
Provider Name (Legal Business Name): TOWNSHIP OF GREEN LAKE GRAND TRAVERSE COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 11/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9394 10TH ST
INTERLOCHEN MI
49643
US

IV. Provider business mailing address

PO BOX 747
WHEELING IL
60090-0747
US

V. Phone/Fax

Practice location:
  • Phone: 231-276-6297
  • Fax: 231-276-9388
Mailing address:
  • Phone: 800-244-2345
  • Fax: 800-329-5274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number281005
License Number StateMI

VIII. Authorized Official

Name: MR. MICHAEL STINSON
Title or Position: FIRE CAPTAIN
Credential:
Phone: 231-276-6297