=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336578855
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FAMILY LIVING AFC, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/05/2013
-----------------------------------------------------
Last Update Date | 11/05/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6254 N 37TH ST
-----------------------------------------------------
City | RICHLAND
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49083-9682
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 269-731-4025
-----------------------------------------------------
Fax | 269-731-5195
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6254 N 37TH ST
-----------------------------------------------------
City | RICHLAND
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49083-9682
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 269-731-4025
-----------------------------------------------------
Fax | 269-731-5195
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PRESIDENT
-----------------------------------------------------
Name | PATRICIA CRAWFORD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 269-731-4025
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 311Z00000X
-----------------------------------------------------
Taxonomy Name | Custodial Care Facility
-----------------------------------------------------
License Number | AF390254614
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------