Provider Demographics
NPI:1699844498
Name:TOWNSHIP OF GROVELAND MI
Entity Type:Organization
Organization Name:TOWNSHIP OF GROVELAND MI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:AX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-634-4152
Mailing Address - Street 1:P.O. BOX 420155
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48342-0155
Mailing Address - Country:US
Mailing Address - Phone:248-338-9097
Mailing Address - Fax:248-338-9364
Practice Address - Street 1:14645 DIXIE HWY.
Practice Address - Street 2:
Practice Address - City:HOLLY
Practice Address - State:MI
Practice Address - Zip Code:48442-9631
Practice Address - Country:US
Practice Address - Phone:248-634-7722
Practice Address - Fax:248-634-0600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI631047341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI183370417Medicaid
MI183370417Medicaid