Provider Demographics
NPI:1780623660
Name:CITY OF GROSSE POINTE PARK
Entity type:Organization
Organization Name:CITY OF GROSSE POINTE PARK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:HILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-822-4416
Mailing Address - Street 1:15115 E JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48230-1312
Mailing Address - Country:US
Mailing Address - Phone:313-822-7400
Mailing Address - Fax:313-822-4543
Practice Address - Street 1:15115 E JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE PARK
Practice Address - State:MI
Practice Address - Zip Code:48230-1312
Practice Address - Country:US
Practice Address - Phone:313-822-7400
Practice Address - Fax:313-822-4543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI821011341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI183003795Medicaid
MI183003795Medicaid