Provider Demographics
NPI:1871662791
Name:VILLAGE OF GROSSE POINTE SHORES
Entity Type:Organization
Organization Name:VILLAGE OF GROSSE POINTE SHORES
Other - Org Name:GROSSE POINTE SHORES DPS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF DPS
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:V
Authorized Official - Last Name:WERENSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-881-5501
Mailing Address - Street 1:795 LAKE SHORE RD
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48236-1455
Mailing Address - Country:US
Mailing Address - Phone:313-881-5500
Mailing Address - Fax:313-640-1661
Practice Address - Street 1:795 LAKE SHORE RD
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE SHORES
Practice Address - State:MI
Practice Address - Zip Code:48236-1455
Practice Address - Country:US
Practice Address - Phone:313-881-5500
Practice Address - Fax:313-640-1661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI821012341600000X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI18-4258028Medicaid
MI18-4258028Medicaid