Provider Demographics
NPI:1649210154
Name:CHARTER TOWNSHIP OF WATERFORD
Entity type:Organization
Organization Name:CHARTER TOWNSHIP OF WATERFORD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:COVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-618-6607
Mailing Address - Street 1:2495 CRESCENT LAKE RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48329-3736
Mailing Address - Country:US
Mailing Address - Phone:248-618-6607
Mailing Address - Fax:248-674-4095
Practice Address - Street 1:2495 CRESCENT LAKE RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48329-3736
Practice Address - Country:US
Practice Address - Phone:248-618-7569
Practice Address - Fax:248-674-4095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI631016341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI184637244Medicaid
MI590F323510OtherBCBSM