76TH ST AFC LLC (NPI# 1366982159) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1366982159 |
| Entity Type | Organization |
| Organization Name | 76TH ST AFC LLC |
| Practice Address |
3554 76th St Se Caledonia MI 49316-9113 |
| Mailing Address |
6026 Kalamazoo Ave Se Ste 296 Grand Rapids MI 49508-7018 |
| Practice Telephone | 6166986681 |
| Enumeration Date | 2017-02-28 |
| Last Update Date | 2017-02-28 |
| Authorized Official Name | DEBRA KRAJEWSKI (LICENSEE/DESIGNEE) |
| Authorized Official Telephone | 6163181961 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 311ZA0620X |
Custodial Care Facility Specialization: Adult Care Home |
AM410285883 | MI | Nursing & Custodial Care Facilities |
| Street Address |
3554 76TH ST SE |
| City | CALEDONIA |
| State | MI |
| Zip Code | 49316-9113 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962773408 | Seventy Sixth Street Afc LLC | Respite Care | 3554 76th St Se, Caledonia, MI 49316-9113 | 2012-01-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407326036 | Daina Elizabeth Graves | Occupational Therapist | 10560 Whispering Waters Ln Se, Caledonia, MI 49316 | 2018-11-27 |
| 1033619135 | Spectrum Health Primary Care Partners | Physical Therapist | 6201 68th St Se, Caledonia, MI 49316 | 2018-02-15 |
| 1538672035 | Justin Michael Keely | Student in an Organized Health Care Education/Training Program | 8441 Sunnyview Rd., Caledonia, MI 49316 | 2017-11-07 |
| 1457614521 | Rahaf Halimeh | Dentist | 3625 Riverbed Lane Se, #3, Caledonia, MI 49316 | 2012-06-22 |
| 1487913158 | Adam Zachary Mitchell | Family Medicine | 9090 S Rodgers Ct Se Ste A, Caledonia, MI 49316 | 2012-05-15 |
| 1841588522 | Oday Ali Kasim | Pharmacist | 9375 Cherry Valley Ave., Caledonia, MI 49316 | 2011-07-15 |
| 1417183344 | Allison Leigh Ford | Physical Therapist | 10047 Cross Road Ct. Se, Suite 150, Caledonia, MI 49316 | 2009-06-05 |
| 1336351741 | Paula Delorm | Physical Therapist | 6595 Gracepoint Dr. Se, Caledonia, MI 49316 | 2007-05-06 |
| 1366532798 | Wayne D Westbrook | Dentist | 3125 68th St Se, Dutton, MI 49316 | 2006-10-14 |
| 1629184056 | Patricia Brunck Cassell | Social Worker | 9090 Sourth Rodgers Court Se, Caledonia, MI 49316 | 2006-08-21 |
| Find all providers in zip 49316 | ||||
| Taxonomy Code | 311ZA0620X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Custodial Care Facility |
| Specialization | Adult Care Home |
| A custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment. |
| Notes: [7/1/2003: new] |
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| 1174140420 | Linda Perrault | Custodial Care Facility | 1551 S Hickory Ridge Rd, Milford, MI 48380-1519 | 2020-07-02 |
| 1063039923 | Visel Afc, Inc. | Custodial Care Facility | 6565 Whitneyville Ave Se, Alto, MI 49302-9027 | 2020-06-26 |
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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.