Provider Demographics
NPI:1023058542
Name:SOUTH HAVEN AREA EMERGENCY SERVICES AUTHORITY
Entity type:Organization
Organization Name:SOUTH HAVEN AREA EMERGENCY SERVICES AUTHORITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:HINZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-639-1496
Mailing Address - Street 1:90 BLUE STAR HWY
Mailing Address - Street 2:
Mailing Address - City:SOUTH HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49090-2411
Mailing Address - Country:US
Mailing Address - Phone:269-637-5151
Mailing Address - Fax:269-637-9346
Practice Address - Street 1:90 BLUE STAR HWY
Practice Address - Street 2:
Practice Address - City:SOUTH HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49090-2411
Practice Address - Country:US
Practice Address - Phone:269-637-5151
Practice Address - Fax:269-637-9346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2024-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI8010063416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI184434063Medicaid
MI590012741OtherRAIL ROAD MEDICARE
MI590012741OtherRAIL ROAD MEDICARE