Healthcare Provider Details

I. General information

NPI: 1760557391
Provider Name (Legal Business Name): KINROSS CHARTER TOWNSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 08/09/2024
Certification Date: 08/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5220 W M-80
KINCHELOE MI
49788-1624
US

IV. Provider business mailing address

4884 W CURTIS ST
KINCHELOE MI
49788-1591
US

V. Phone/Fax

Practice location:
  • Phone: 906-495-6062
  • Fax: 906-495-6139
Mailing address:
  • Phone: 908-495-6062
  • Fax: 734-479-6319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number171005
License Number StateMI

VIII. Authorized Official

Name: RENEE GRAY
Title or Position: EMS DIRECTOR
Credential:
Phone: 906-495-6062