Healthcare Provider Details

I. General information

NPI: 1669912440
Provider Name (Legal Business Name): NORTHCROSSING AFC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2017
Last Update Date: 02/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14024 7 MILE RD NE 296
BELDING MI
48809-9624
US

IV. Provider business mailing address

6026 KALAMAZOO AVE SE STE 296
GRAND RAPIDS MI
49508-7018
US

V. Phone/Fax

Practice location:
  • Phone: 616-794-1274
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberAL410286129
License Number StateMI

VIII. Authorized Official

Name: DEBRA KRAJEWSKI
Title or Position: LICENSEE/DESIGNEE
Credential:
Phone: 616-318-1961