# SEVENTY SIXTH STREET AFC LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1962773408
- **Authorized official:** MRS. DEBRA ANN KRAJEWSKI (OWNER)
- **Authorized official phone:** (616) 318-1961

## Contact information

- **Practice address:** 3554 76TH ST SE, CALEDONIA, MI 49316-9113
- **Practice address phone:** (616) 698-6681
- **Practice address fax:** (616) 698-6681
- **Mailing address:** 6026 KALAMAZOO AVE SE, \#296, KENTWOOD, MI 49508-7018
- **Mailing address phone:** (616) 318-1961
- **Mailing address fax:** (616) 891-0838

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 385H00000X | Respite Care | AM410285883 | MI | Yes |

## Other

- **Enumeration date:** 01/14/2012
- **Last updated:** 01/14/2012