Organization
ABBTA INC
Active
Other names
Mt. Vernon AFC
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ADEBIYI BILL AINA LBSW (OWNER/PRESIDENT)
(269) 267-7404
Entity
Organization
Contact information
Practice address
5508 MOUNT VERNON AVE, PORTAGE, MI 49024-1215
(269) 342-5886
Mailing address
PO BOX 1391, PORTAGE, MI 49081-1391
(269) 342-5886
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
AS390290297
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2097746
—
MI
Enumeration date
04/01/2009
Last updated
04/01/2009
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