Healthcare Provider Details

I. General information

NPI: 1306828397
Provider Name (Legal Business Name): CITY OF RIVER ROUGE FIRE DEPT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10600 W JEFFERSON AVE
RIVER ROUGE MI
48218
US

IV. Provider business mailing address

PO BOX 630
WYANDOTTE MI
48192-0630
US

V. Phone/Fax

Practice location:
  • Phone: 313-297-0001
  • Fax: 313-842-4212
Mailing address:
  • Phone: 877-477-4946
  • Fax: 734-246-2990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number088308
License Number StateMI

VIII. Authorized Official

Name: DAVE CIERRILLO
Title or Position: FIRE CHIEF
Credential:
Phone: 313-297-0001