Evergreen Meadow Afc

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

AF410255092 Issued in MI

Legal business name

EVERGREEN MEADOW AFC

Practice address

1944 Buttrick Ave SE
Ada, MI 49301-9204

Phone

(616) 682-0848

NPI assigned

May 11, 2017

Last updated

May 11, 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

Mr. Daniel Patrick Erdman

Title

Afc Operator/Owner

Phone

(616) 682-0848

Specialties & licenses 1

Addresses

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.

• Annelise Erdman, B.S.W.

  • Case Manager/Care Coordinator
  • Grand Rapids, MI
  • NPI 1184778409
  NPD (past)

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

{
    "created_epoch": "1494460800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1494460800000",
    "number": "1730616509",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1944 BUTTRICK AVE SE",
            "city": "ADA",
            "state": "MI",
            "postal_code": "493019204",
            "telephone_number": "616-682-0848"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1944 BUTTRICK AVE SE",
            "city": "ADA",
            "state": "MI",
            "postal_code": "493019204",
            "telephone_number": "616-682-0848"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN MEADOW AFC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-11",
        "last_updated": "2017-05-11",
        "status": "A",
        "authorized_official_last_name": "ERDMAN",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "PATRICK",
        "authorized_official_title_or_position": "AFC OPERATOR/OWNER",
        "authorized_official_telephone_number": "616-682-0848",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "MI",
            "license": "AF410255092",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Suzanne Michele Edwards, CTRS, CDES
• Daniel Keith Ehnis, EDD
• Karen Marie Elbert, LMSW
• Endurance Rehabilitation & Athletics PLLC
• Kathleen Ann Esch, R.N.
• Travis James Faulkner
• Karen Feaster
• Jamal Fisher, MSW, LMSW
• Tracy Flanders, MT-BC
• Robert Flannigan, DC

• Adult Care Home Facility in Ada, MI
• Providers in Ada, 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 May 11, 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.