Terry Drive Afc LLC

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

AS410298938 Issued in MI

Legal business name

TERRY DRIVE AFC LLC

Practice address

4638 Terry Dr SE
Grand Rapids, MI 49512-5321

Phone

(616) 318-1961

NPI assigned

Feb 28, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Debra Krajewski

Title

Licensee/Designee

Phone

(616) 318-1961

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1488240000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1488240000000",
    "number": "1356881148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6026 KALAMAZOO AVE SE",
            "address_2": "STE 296",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495087018"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4638 TERRY DR SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495125321",
            "telephone_number": "616-318-1961"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TERRY DRIVE AFC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-28",
        "last_updated": "2017-02-28",
        "status": "A",
        "authorized_official_last_name": "KRAJEWSKI",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_title_or_position": "LICENSEE/DESIGNEE",
        "authorized_official_telephone_number": "616-318-1961"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "MI",
            "license": "AS410298938",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shelby Nicole Terpstra
• Samuel Terranova, NP
• Michael David Terrell, PT
• Michelle Terrell, MS PT
• Susan Marie Terrell, MD
• Anndrea Terry, LPC
• Jordan Terry, MD
• Mareena Lynn Terry
• Rodney Terry, MSW
• Travonna Terry

• Adult Care Home Facility in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Adult Care Home Facility in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.