Organization
GREEN ACRES AFC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SARAH LOUISE MINER AFC LICENSEE (LICENSEE/OWNER)
(231) 632-8810
Entity
Organization
Contact information
Practice address
127 POTTER RD W, TRAVERSE CITY, MI 49696-8525
(231) 947-7055
(231) 947-7060
Mailing address
9822 N LONG LAKE RD, TRAVERSE CITY, MI 49685-9106
(231) 632-8810
Taxonomy
Speciality
Code
Description
License number
State
253J00000X
Foster Care Agency
Primary
AG280278926
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AG280278926
ADULT FOSTER CARE
MI
05
—
AG280278926
—
MI
Enumeration date
08/04/2017
Last updated
08/04/2017
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