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General NPI Number Information
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NPI Number | 1124300553
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Entity Type | Organization
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Legal Business Name | NAVY
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Dates
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Enumeration Date | 09/12/2011
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Last Update Date | 09/12/2011
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Provider Practice Location Address
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Address Line | 6683 GAWLEY RD
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City | HOWELL
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State | MI
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Zip | 48843-8964
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Country | US
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Telephone | 810-533-0552
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Fax |
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Provider Business Mailing Address
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Address Line | 6683 GAWLEY RD
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City | HOWELL
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State | MI
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Zip | 48843-8964
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Country | US
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Telephone | 810-533-0552
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Fax |
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Authorized Official
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Title or Position | IDC
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Name | MR. SEAN P SPARE
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Credential |
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Telephone | 810-533-0552
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 284300000X
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Taxonomy Name | Special Hospital
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License Number |
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License Number State |
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