Healthcare Provider Details

I. General information

NPI: 1730013038
Provider Name (Legal Business Name): COUNTRY HOUSE AFC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1977 N KOHLER RD
TRUFANT MI
49347-9715
US

IV. Provider business mailing address

1977 N KOHLER RD
TRUFANT MI
49347-9715
US

V. Phone/Fax

Practice location:
  • Phone: 231-349-1016
  • Fax:
Mailing address:
  • Phone: 231-349-1016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MARIANNE SCHWANDT
Title or Position: OWNER
Credential: SCHWANDT
Phone: 231-349-1016