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General NPI Number Information
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NPI Number | 1336663061
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Entity Type | Organization
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Legal Business Name | FAMILY TREE ADULT FOSTER CARE, INC.
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Dates
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Enumeration Date | 08/03/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 6699 N OCEANA DR
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City | HART
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State | MI
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Zip | 49420-8422
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Country | US
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Telephone | 231-873-7737
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Fax |
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Provider Business Mailing Address
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Address Line | 6699 N OCEANA DR
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City | HART
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State | MI
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Zip | 49420-8422
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Country | US
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Telephone | 231-873-7737
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT/ADMINISTRATOR
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Name | MRS. TRACIE ELIZABETH PARKER
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Credential |
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Telephone | 231-873-7737
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | AM640384872
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License Number State | MI
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