Bluebird Afc Manor

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

AF410075156 Issued in MI

Legal business name

BLUEBIRD AFC MANOR

Practice address

3571 Bluebird Ave SW
Wyoming, MI 49519-3103

Phone

(616) 261-0994

Fax

(616) 259-7892

NPI assigned

Feb 15, 2017

Organization subpart

No

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

Authorized official

Name

Beth Ann Skazinski

Title

Licensee/Owner

Phone

(616) 261-0994

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1487116800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1487116800000",
    "number": "1871032417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3571 BLUEBIRD AVE SW",
            "city": "WYOMING",
            "state": "MI",
            "postal_code": "495193103",
            "telephone_number": "616-261-0994",
            "fax_number": "616-259-7892"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3571 BLUEBIRD AVE SW",
            "city": "WYOMING",
            "state": "MI",
            "postal_code": "495193103",
            "telephone_number": "616-261-0994",
            "fax_number": "616-259-7892"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUEBIRD AFC MANOR",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-15",
        "last_updated": "2017-02-15",
        "status": "A",
        "authorized_official_last_name": "SKAZINSKI",
        "authorized_official_first_name": "BETH",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "LICENSEE/OWNER",
        "authorized_official_telephone_number": "616-261-0994"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "MI",
            "license": "AF410075156",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9830425",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Blanchette, LLP
• Ruperto Divino Blanco Jr., MD
• Isabel Anna Marie Blanks
• Sharell Shonteaja Blanks
• Kari Sue Blech, MSN, RN, FNP-BC
• Kelsey Blystone, RN
• Gregg David Bobier, DMD
• Janet L Bodemann
• Hannah Elizabeth Boersma
• Elizabeth A Boessenkool, MD

• Adult Care Home Facility in Wyoming, MI
• Providers in Wyoming, 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 15, 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.