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Organization
BOLDEN AFC LLC
Active
Organization
BOLDEN AFC LLC
Active
Parent organization
BOLDEN AFC LLC
Other names
Diamond Pointe
Organization subpart
Yes
Provider details
NPI number
Legal business name
BOLDEN AFC LLC
Authorized official
DORTHIE BOLDEN (OWNER/SUPERVISOR)
(269) 214-2142
Entity
Organization
Contact information
Practice address
7027 BASELINE RD, SOUTH HAVEN, MI 49090-8338
(269) 214-2142
Mailing address
71871 10TH AVE, SOUTH HAVEN, MI 49090-9132
(268) 214-2142
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1235789553
—
MI
Enumeration date
10/18/2019
Last updated
10/18/2019
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