Healthcare Provider Details

I. General information

NPI: 1679396733
Provider Name (Legal Business Name): KEKELIS AFC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2024
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

731 LOUISA ST
LANSING MI
48911-5144
US

IV. Provider business mailing address

PO BOX 26243
LANSING MI
48909-6243
US

V. Phone/Fax

Practice location:
  • Phone: 517-980-1925
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number
License Number State

VIII. Authorized Official

Name: ANNA MASAMBAJI
Title or Position: DIRECTOR
Credential:
Phone: 517-980-1925