Country Living Adult Foster Care

Primary specialty

Assisted Living Facility (Mental Illness)Taxonomy code 3104A0625X

License

AS540307174 Issued in MI

Legal business name

COUNTRY LIVING ADULT FOSTER CARE

Practice address

16966 6 Mile Rd
Stanwood, MI 49346-9104

Phone

(231) 823-2061

Fax

(231) 823-2061

NPI assigned

Feb 26, 2011

Last updated

Feb 26, 2011By 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

Ms. Gail Ann Dawson

Title

Owner

Phone

(231) 823-2061

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1298678400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1298678400000",
    "number": "1619274669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16966 6 MILE RD",
            "city": "STANWOOD",
            "state": "MI",
            "postal_code": "493469104",
            "telephone_number": "231-823-2061",
            "fax_number": "231-823-2061"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16966 6 MILE RD",
            "city": "STANWOOD",
            "state": "MI",
            "postal_code": "493469104",
            "telephone_number": "231-823-2061",
            "fax_number": "231-823-2061"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRY LIVING ADULT FOSTER CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-26",
        "last_updated": "2011-02-26",
        "status": "A",
        "authorized_official_last_name": "DAWSON",
        "authorized_official_first_name": "GAIL",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "231-823-2061",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "3104A0625X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Mental Illness",
            "state": "MI",
            "license": "AS540307174",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE #",
            "identifier": "AS540307174",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Assisted Living Facility (Mental Illness) in Stanwood, MI
• Providers in Stanwood, MI by specialty
• Assisted Living Facility (Mental Illness) in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2011; 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.