Provider Demographics
NPI:1881621837
Name:NEWBERG TOWNSHIP
Entity type:Organization
Organization Name:NEWBERG TOWNSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FORRESTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-244-5283
Mailing Address - Street 1:PO BOX 37
Mailing Address - Street 2:
Mailing Address - City:JONES
Mailing Address - State:MI
Mailing Address - Zip Code:49061-0037
Mailing Address - Country:US
Mailing Address - Phone:269-244-5283
Mailing Address - Fax:269-244-5283
Practice Address - Street 1:11900 MCKINLEY ST
Practice Address - Street 2:
Practice Address - City:JONES
Practice Address - State:MI
Practice Address - Zip Code:49061-0257
Practice Address - Country:US
Practice Address - Phone:269-244-8504
Practice Address - Fax:269-244-5766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI141005341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2837531Medicaid
MI2837531Medicaid