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General NPI Number Information
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NPI Number | 1376059238
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Entity Type | Organization
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Legal Business Name | SPECIAL DRIVING SERVICES, INC.
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Dates
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Enumeration Date | 12/14/2017
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Last Update Date | 12/14/2017
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Provider Practice Location Address
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Address Line | 3945 OKEMOS RD STE A5
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City | OKEMOS
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State | MI
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Zip | 48864-4207
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Country | US
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Telephone | 517-349-7990
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Fax | 517-489-4781
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Provider Business Mailing Address
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Address Line | PO BOX 241
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City | OKEMOS
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State | MI
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Zip | 48805-0241
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Country | US
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Telephone | 517-349-7990
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Fax | 517-489-4781
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | MR. ROBERT E. REID
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Credential | ED.S, CDRS,CBIS, CDI
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Telephone | 517-489-1700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | P000648
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License Number State | MI
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