76TH St Afc LLC

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

AM410285883 Issued in MI

Legal business name

76TH ST AFC LLC

Practice address

3554 76TH St SE
Caledonia, MI 49316-9113

Phone

(616) 698-6681

NPI assigned

Feb 28, 2017

Last updated

Feb 28, 2017By the provider in NPPES

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

Tax ID family

76TH St Afc LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Deepwood Afc LLC

  • Adult Care Home Facility
  • Wyoming, MI
  • NPI 1730629510
  NPD tax ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• James Nelson, DPM

  • Podiatrist
  • Wyoming, MI
  • NPI 1346356219
  NPD (past)

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": "1366982159",
    "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": "3554 76TH ST SE",
            "city": "CALEDONIA",
            "state": "MI",
            "postal_code": "493169113",
            "telephone_number": "616-698-6681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "76TH ST 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": "AM410285883",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Adult Care Home Facility in Caledonia, MI
• Providers in Caledonia, 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.