Healthcare Provider Details

I. General information

NPI: 1538103619
Provider Name (Legal Business Name): CHARTER TOWNSHIP OF WEST BLOOMFIELD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 04/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5425 W. MAPLE RD.
WEST BLOOMFIELD MI
48322-3035
US

IV. Provider business mailing address

PO BOX 2122
RIVERVIEW MI
48193-1122
US

V. Phone/Fax

Practice location:
  • Phone: 248-409-1505
  • Fax: 248-406-0060
Mailing address:
  • Phone: 734-479-6300
  • Fax: 734-479-6319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number341600000X
License Number StateMI

VIII. Authorized Official

Name: MR. GREG FLYNN
Title or Position: EMS COORDINATOR
Credential: EMT P IC
Phone: 248-409-1505