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General NPI Number Information
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NPI Number | 1376355412
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Entity Type | Organization
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Legal Business Name | EXECUTIVE BUSINESS
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Dates
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Enumeration Date | 01/24/2025
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Last Update Date | 01/24/2025
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Provider Practice Location Address
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Address Line | 9555 SAINT MARYS ST
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City | DETROIT
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State | MI
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Zip | 48227-1657
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Country | US
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Telephone | 313-315-1637
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Fax |
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Provider Business Mailing Address
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Address Line | 9555 SAINT MARYS ST
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City | DETROIT
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State | MI
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Zip | 48227-1657
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Country | US
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Telephone | 313-315-1637
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | KENNETH TATE
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Credential | D.D
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Telephone | 313-315-1637
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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 |
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License Number State |
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