Healthcare Provider Details

I. General information

NPI: 1700618030
Provider Name (Legal Business Name): PAYTON'S AFC HOME INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2024
Last Update Date: 08/16/2024
Certification Date: 08/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5520 KUZMICK RD
ELMIRA MI
49730-9534
US

IV. Provider business mailing address

5520 KUZMICK RD
ELMIRA MI
49730-9534
US

V. Phone/Fax

Practice location:
  • Phone: 231-881-5999
  • Fax: 231-549-3477
Mailing address:
  • Phone: 231-881-5999
  • Fax: 231-549-3477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State

VIII. Authorized Official

Name: PAYTON BAUMAN
Title or Position: OWNER
Credential:
Phone: 231-881-5999