Provider Demographics
NPI:1295020139
Name:EAST GRAND LAKE VOLUNTEER FIRE DEPT
Entity Type:Organization
Organization Name:EAST GRAND LAKE VOLUNTEER FIRE DEPT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BILLING
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-318-3756
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:PRESQUE ISLE
Mailing Address - State:MI
Mailing Address - Zip Code:49777-0009
Mailing Address - Country:US
Mailing Address - Phone:989-595-2412
Mailing Address - Fax:
Practice Address - Street 1:8959 E GRAND LAKE RD
Practice Address - Street 2:
Practice Address - City:PRESQUE ISLE
Practice Address - State:MI
Practice Address - Zip Code:49777-8633
Practice Address - Country:US
Practice Address - Phone:989-595-2412
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-17
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI711001341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance