Organization
76TH ST AFC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBRA KRAJEWSKI (LICENSEE/DESIGNEE)
(616) 318-1961
Entity
Organization
Contact information
Practice address
3554 76TH ST SE, CALEDONIA, MI 49316-9113
(616) 698-6681
Mailing address
6026 KALAMAZOO AVE SE, STE 296, GRAND RAPIDS, MI 49508-7018
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
AM410285883
MI
Other
Enumeration date
02/28/2017
Last updated
02/28/2017
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