NPIMap

Organization Active NPI

Deepwood Afc LLC

  • Adult Care Home Facility
  • Wyoming, MI
National Provider Identifier
1730629510
Registry record updated Feb 28, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Care Home FacilityTaxonomy code 311ZA0620X
License
AS410284040 Issued in MI
Legal business name
DEEPWOOD AFC LLC
Practice address
1767 Deepwood Dr SW
Wyoming, MI 49519-6556
Phone
(616) 531-1023
NPI assigned
Feb 28, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2017

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

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Care Home Facility 311ZA0620X AS410284040 MI Primary

Addresses

Primary practice location

1767 Deepwood Dr SW
Wyoming, MI 49519-6556

Mailing address

6026 Kalamazoo Ave SE
Ste 296
Grand Rapids, MI 49508-7018

National Provider Directory

National Provider Directory
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.

NPI Registry JSON

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": "1730629510",
    "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": "1767 DEEPWOOD DR SW",
            "city": "WYOMING",
            "state": "MI",
            "postal_code": "495196556",
            "telephone_number": "616-531-1023"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEEPWOOD 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": "AS410284040",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wyoming, MI

Sources for this page

  • 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.