BOLDEN AFC LLC (NPI# 1225671621) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1225671621 |
| Entity Type | Organization |
| Organization Name | BOLDEN AFC LLC |
| Practice Address |
7027 Baseline Rd South Haven MI 49090-8338 |
| Mailing Address |
71871 10th Ave South Haven MI 49090-9132 |
| Practice Telephone | 2692142142 |
| Mailing Telephone | 2682142142 |
| Enumeration Date | 2019-10-18 |
| Last Update Date | 2019-10-18 |
| Authorized Official Name | DORTHIE BOLDEN (OWNER/SUPERVISOR) |
| Authorized Official Telephone | 2692142142 |
| Is Organization Subpart | Y |
| Parent Organization Name | BOLDEN AFC LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 320600000X | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | Residential Treatment Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | 1235789553 | 05 |
| Other Name | Type Code |
|---|---|
| Diamond Pointe | Doing Business As Name - Organization |
| Street Address |
7027 BASELINE RD |
| City | SOUTH HAVEN |
| State | MI |
| Zip Code | 49090-8338 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235789553 | Dorthie Bolden | Foster Care Agency | 7027 Baseline Rd, South Haven, MI 49090-8338 | 2019-09-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295234490 | Katara Therapy, LLC | Social Worker | 13560 76th Street, Suite 3, South Haven, MI 49090 | 2018-02-03 |
| 1487022091 | Kevin E. Ferrell | Physician Assistant | 955 S. Bailey Avenue, South Haven, MI 49090 | 2015-09-14 |
| 1942638002 | Birdie Farley | Chore Provider | 26725 M-140 Hwy, South Haven, MI 49090 | 2013-10-28 |
| 1730514910 | Rebecca A. Bennett | Counselor | 1675 Phoenix Road, Suite 9, South Haven, MI 49090 | 2013-09-06 |
| 1902149818 | Bronson South Haven Hospital | Emergency Medicine | 970 S Bailey Ave, South Haven, MI 49090 | 2013-03-28 |
| 1265629927 | Cecilia Liz Vives Vasquez | Physical Therapist | 23701 Red Arrow Hwy, Mattawan, MI 49090 | 2007-09-26 |
| 1518089788 | Donald Jam,es Buckley | Pharmacist | 955 S Bailey, South Haven, MI 49090 | 2007-04-06 |
| 1366568966 | Norman M Maly | Dentist | 05055 Blue Star Hwy, South Haven, MI 49090 | 2007-03-22 |
| 1639264062 | Deborah Sue Distefano | Pharmacy Technician | 512 Phoenix Street, South Haven, MI 49090 | 2006-10-03 |
| 1053357897 | Stephen Earl Tolen | Chiropractor | 325 Superior St., South Haven, MI 49090 | 2006-06-21 |
| Find all providers in zip 49090 | ||||
| Taxonomy Code | 320600000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
| A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental disabilities and/or mental retardation and are not able to live independently. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770199507 | Laura Lisa Gonzalez | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 7134 Blankenship Cir, Davison, MI 48423-2317 | 2020-09-17 |
| 1558984377 | Angel Patient Inc. | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 12601 E Outer Dr, Detroit, MI 48224-4204 | 2020-05-27 |
| 1659990208 | Lydias House | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 11667 152nd Ave, West Olive, MI 49460-9232 | 2020-04-14 |
| 1124667118 | Alternative Community Living, Inc. | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 2678 S Waverly Hwy, Lansing, MI 48911-6303 | 2019-12-23 |
| 1215579537 | Eden Prairie Residential Care Services, LLC | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 302 Welch Blvd, Flint, MI 48503-1105 | 2019-10-09 |
| 1518428333 | Alternative Adult Residence LLC | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 19163 Woodingham Dr, Detroit, MI 48221-1650 | 2019-03-26 |
| 1245701960 | Teresa Elaine Guzman | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 130 Marvin St, Battle Creek, MI 49017-8040 | 2018-12-06 |
| 1508334764 | Marquette Staffing Agency, Inc. | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 592 Blemhuber Ave, Marquette, MI 49855-4818 | 2018-11-06 |
| 1912481235 | Adrienne Flowers | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 18403 Kentucky St, Detroit, MI 48221-2029 | 2018-09-21 |
| 1417431487 | Helping Hands Services | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 5116 18th Rd, Escanaba, MI 49829-9525 | 2018-09-17 |
| Find all providers with the same taxonomy | ||||
| City | SOUTH HAVEN |
| Zip Code | 49090 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.