Provider Demographics
NPI:1972541563
Name:CHARTER TOWNSHIP OF SHELBY
Entity Type:Organization
Organization Name:CHARTER TOWNSHIP OF SHELBY
Other - Org Name:SHELBY TOWNSHIP FIRE DEPARTMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:EMS COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAPPELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-726-2705
Mailing Address - Street 1:PO BOX 2122
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:MI
Mailing Address - Zip Code:48193-1122
Mailing Address - Country:US
Mailing Address - Phone:734-479-6300
Mailing Address - Fax:734-479-6319
Practice Address - Street 1:6345 23 MILE RD
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48316-4405
Practice Address - Country:US
Practice Address - Phone:586-731-3476
Practice Address - Fax:586-726-4553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0856553416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI184104774Medicaid
MI184104774Medicaid