Healthcare Provider Details

I. General information

NPI: 1053709212
Provider Name (Legal Business Name): DOWN RIVER X-PRESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2014
Last Update Date: 01/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 CHARLES ST
RIVER ROUGE MI
48218-1114
US

IV. Provider business mailing address

146 CHARLES ST
RIVER ROUGE MI
48218-1114
US

V. Phone/Fax

Practice location:
  • Phone: 313-458-2201
  • Fax:
Mailing address:
  • Phone: 313-458-2201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateMI

VIII. Authorized Official

Name: JAVON GRIFFIN
Title or Position: PRESIDENT
Credential:
Phone: 313-978-8450