Healthcare Provider Details

I. General information

NPI: 1669814356
Provider Name (Legal Business Name): A NEW BEGINNING ASSISSSTED LIVING/ AFC HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2013
Last Update Date: 07/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

298 HAWLEY ST
HESPERIA MI
49421-9782
US

IV. Provider business mailing address

193 S ELM ST
HESPERIA MI
49421-9329
US

V. Phone/Fax

Practice location:
  • Phone: 231-854-0131
  • Fax:
Mailing address:
  • Phone: 231-854-0131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberAS640295294
License Number StateMI

VIII. Authorized Official

Name: DONNA MARIE CROSS
Title or Position: OWNER/CAREGIVER
Credential:
Phone: 231-854-0131