Green Acres Afc

Primary specialty

Foster Care AgencyTaxonomy code 253J00000X

License

AG280278926 Issued in MI

Legal business name

GREEN ACRES AFC

Practice address

127 Potter Rd W
Traverse City, MI 49696-8525

Phone

(231) 947-7055

Fax

(231) 947-7060

NPI assigned

Aug 4, 2017

Last updated

Aug 4, 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

Ms. Sarah Louise Miner, AFC LICENSEE

Title

Licensee/Owner

Phone

(231) 632-8810

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1501804800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1501804800000",
    "number": "1922523505",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9822 N LONG LAKE RD",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496859106",
            "telephone_number": "231-632-8810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "127 POTTER RD W",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496968525",
            "telephone_number": "231-947-7055",
            "fax_number": "231-947-7060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREEN ACRES AFC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-04",
        "last_updated": "2017-08-04",
        "status": "A",
        "authorized_official_last_name": "MINER",
        "authorized_official_first_name": "SARAH",
        "authorized_official_middle_name": "LOUISE",
        "authorized_official_title_or_position": "LICENSEE/OWNER",
        "authorized_official_telephone_number": "231-632-8810",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "AFC LICENSEE"
    },
    "taxonomies": [
        {
            "code": "253J00000X",
            "taxonomy_group": "",
            "desc": "Foster Care Agency",
            "state": "MI",
            "license": "AG280278926",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "AG280278926",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ADULT FOSTER CARE",
            "identifier": "AG280278926",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Katherine Green
• Nicole Lynn Green
• Taryn Green, PTA

• Foster Care Agency in Traverse City, MI
• Providers in Traverse City, MI by specialty
• Foster Care Agency in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 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.