Organization
ESPANOLA HOUSE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID L CONNER (OWNER)
(269) 330-2397
Entity
Organization
Contact information
Practice address
422 ESPANOLA AVE, PARCHMENT, MI 49004-1139
(269) 220-5095
Mailing address
422 ESPANOLA AVE, PARCHMENT, MI 49004-1139
(269) 220-5095
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AS390381707
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AS390381707
AFC HOME LICENSE
MI
Enumeration date
05/10/2017
Last updated
05/10/2017
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