1003851973 NPI number — CITY OF WOODHAVEN

Table of content: (NPI 1003851973)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003851973 NPI number — CITY OF WOODHAVEN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF WOODHAVEN
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003851973
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2122
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIVERVIEW
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48193-1122
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-224-4474
Provider Business Mailing Address Fax Number:
734-479-6319

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23040 HALL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOODHAVEN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48183-3206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-675-4918
Provider Business Practice Location Address Fax Number:
734-675-4947
Provider Enumeration Date:
06/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MYLES
Authorized Official First Name:
BRADLEY
Authorized Official Middle Name:
ALAN
Authorized Official Title or Position:
FIRE CHIEF
Authorized Official Telephone Number:
734-675-4918

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  821030 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 28227034 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 590006642 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".




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