Provider Demographics
NPI:1487722682
Name:CITY OF ECORSE
Entity type:Organization
Organization Name:CITY OF ECORSE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:FRANKLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-779-9032
Mailing Address - Street 1:3869 W JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:ECORSE
Mailing Address - State:MI
Mailing Address - Zip Code:48229-1701
Mailing Address - Country:US
Mailing Address - Phone:313-381-6889
Mailing Address - Fax:313-386-8162
Practice Address - Street 1:3869 W JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:ECORSE
Practice Address - State:MI
Practice Address - Zip Code:48229-1701
Practice Address - Country:US
Practice Address - Phone:313-381-6889
Practice Address - Fax:313-386-8162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI8210053416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI183005109Medicaid
MI590H200990OtherBLUE CROSS BLUE SHIELD
MI183005109Medicaid