Marcia Lucille Koza

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

AM410416004 Issued in MI

Practice address

12955 68TH St SE
Alto, MI 49302

Phone

(616) 868-0001

Fax

(616) 868-0030

NPI assigned

Jul 19, 2023

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Sandy'S Country Afc

  • Adult Care Home Facility
  • Alto, MI
  • NPI 1386183911
  NPD (past)

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

{
    "created_epoch": "1689724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689724800000",
    "number": "1598445124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12955 68TH ST SE",
            "city": "ALTO",
            "state": "MI",
            "postal_code": "49302",
            "telephone_number": "616-868-0001",
            "fax_number": "616-868-0030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12955 68TH ST SE",
            "city": "ALTO",
            "state": "MI",
            "postal_code": "49302",
            "telephone_number": "616-868-0001",
            "fax_number": "616-868-0030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOZA",
        "first_name": "MARCIA",
        "middle_name": "LUCILLE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-07-19",
        "last_updated": "2023-07-19",
        "certification_date": "2023-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "MI",
            "license": "AM410416004",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Bowden, M.D.
• Debra Sue Devilbiss
• Evan Deward
• Brooke Ann Fox, CTRS
• Debra J Hoekstra, LPN
• Anne Krebill
• Sarah Suzanne Miller
• New Luna Therapy
• Radical Health & Wellness
• Randall Wolthuis, PH.D. LLC

• Adult Care Home Facility in Alto, MI
• Providers in Alto, 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 Jul 19, 2023; 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.