1306828397 NPI number — CITY OF RIVER ROUGE FIRE DEPT

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306828397 NPI number — CITY OF RIVER ROUGE FIRE DEPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF RIVER ROUGE FIRE DEPT
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:
1306828397
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 630
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WYANDOTTE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48192-0630
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
877-477-4946
Provider Business Mailing Address Fax Number:
734-246-2990

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10600 W JEFFERSON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIVER ROUGE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-297-0001
Provider Business Practice Location Address Fax Number:
313-842-4212
Provider Enumeration Date:
11/16/2005

Additional Information

Authorized Official

Authorized Official Last Name:
CIERRILLO
Authorized Official First Name:
DAVE
Authorized Official Middle Name:
Authorized Official Title or Position:
FIRE CHIEF
Authorized Official Telephone Number:
313-297-0001

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  088308 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3004380 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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