Organization
SANDY'S COUNTRY AFC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SANDRA JEAN AMBRUS (LICENSEE/OWNER)
(616) 868-0001
Entity
Organization
Contact information
Practice address
12955 68TH ST SE, ALTO, MI 49302-9741
(616) 868-0001
(616) 868-0030
Mailing address
12955 68TH ST SE, ALTO, MI 49302-9741
(616) 868-0001
(616) 868-0030
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
AM410281990
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9455674
—
MI
Enumeration date
02/15/2017
Last updated
02/15/2017
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