Organization
COUNTRY LIVING ADULT FOSTER CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. GAIL ANN DAWSON (OWNER)
(231) 823-2061
Entity
Organization
Contact information
Practice address
16966 6 MILE RD, STANWOOD, MI 49346-9104
(231) 823-2061
(231) 823-2061
Mailing address
16966 6 MILE RD, STANWOOD, MI 49346-9104
(231) 823-2061
(231) 823-2061
Taxonomy
Speciality
Code
Description
License number
State
3104A0625X
Assisted Living Facility (Mental Illness)
Primary
AS540307174
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AS540307174
LICENSE #
MI
Enumeration date
02/26/2011
Last updated
02/26/2011
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