Organization
SEVENTY SIXTH STREET AFC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DEBRA ANN KRAJEWSKI (OWNER)
(616) 318-1961
Entity
Organization
Contact information
Practice address
3554 76TH ST SE, CALEDONIA, MI 49316-9113
(616) 698-6681
(616) 698-6681
Mailing address
6026 KALAMAZOO AVE SE, #296, KENTWOOD, MI 49508-7018
(616) 318-1961
(616) 891-0838
Taxonomy
Speciality
Code
Description
License number
State
385H00000X
Respite Care
Primary
AM410285883
MI
Other
Enumeration date
01/14/2012
Last updated
01/14/2012
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