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General NPI Number Information
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NPI Number | 1285964148
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Entity Type | Organization
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Legal Business Name | CLAY CIVIL TOWNSHIP
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Dates
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Enumeration Date | 12/28/2009
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Last Update Date | 03/01/2024
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Provider Practice Location Address
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Address Line | 18355 AUTEN RD
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City | SOUTH BEND
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State | IN
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Zip | 46637-2608
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Country | US
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Telephone | 574-272-2144
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2122
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City | RIVERVIEW
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State | MI
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Zip | 48193-1122
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | FIRE CHIEF
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Name | JAREN KILIAN
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Credential |
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Telephone | 574-272-2144
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 341600000X
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Taxonomy Name | Ambulance
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License Number | 0394
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number |
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License Number State |
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