Healthcare Provider Details

I. General information

NPI: 1215858360
Provider Name (Legal Business Name): REHOBOTH AFC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2990 138TH AVE
DORR MI
49323-9533
US

IV. Provider business mailing address

9505 HOMERICH AVE SW
BYRON CENTER MI
49315-8889
US

V. Phone/Fax

Practice location:
  • Phone: 616-371-7260
  • Fax: 616-371-7270
Mailing address:
  • Phone: 616-610-4097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376G00000X
TaxonomyNursing Home Administrator
License Number
License Number State

VIII. Authorized Official

Name: MRS. JENNIFER J ZANDSTRA
Title or Position: ADMINISTRATOR
Credential:
Phone: 616-610-4097