Healthcare Provider Details

I. General information

NPI: 1508305921
Provider Name (Legal Business Name): AMANT AFC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2017
Last Update Date: 02/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1018 WIDDICOMB AVE NW
GRAND RAPIDS MI
49504-4130
US

IV. Provider business mailing address

1018 WIDDICOMB AVE NW
GRAND RAPIDS MI
49504-4130
US

V. Phone/Fax

Practice location:
  • Phone: 616-228-4624
  • Fax: 616-588-6048
Mailing address:
  • Phone: 616-228-4624
  • Fax: 616-588-6048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberAF410379501
License Number StateMI

VIII. Authorized Official

Name: ASHLEY B DEBOER
Title or Position: OWNER
Credential:
Phone: 616-818-2472