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General NPI Number Information
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NPI Number | 1326584756
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Entity Type | Organization
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Legal Business Name | THE FREZGHI GROUP LLC
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Dates
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Enumeration Date | 01/09/2017
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Last Update Date | 01/09/2017
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Provider Practice Location Address
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Address Line | 1701 COUNTRY CLUB DR NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49505-4808
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Country | US
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Telephone | 616-304-1201
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Fax |
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Provider Business Mailing Address
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Address Line | 1701 COUNTRY CLUB DR NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49505-4808
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Country | US
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Telephone | 616-304-1201
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. MEAZA GEBREAMLAK
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Credential |
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Telephone | 616-304-1201
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number | G165599288056
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License Number State | MI
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