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General NPI Number Information
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NPI Number | 1386312213
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Entity Type | Organization
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Legal Business Name | COUNTRY CREEK AFC, INC.
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Dates
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Enumeration Date | 09/03/2021
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Last Update Date | 09/03/2021
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Provider Practice Location Address
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Address Line | 2771 LAMB RD
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City | MASON
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State | MI
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Zip | 48854-9316
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Country | US
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Telephone | 517-676-1070
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Fax |
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Provider Business Mailing Address
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Address Line | 1600 E GRAND RIVER AVE
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City | EAST LANSING
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State | MI
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Zip | 48823-4909
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Country | US
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Telephone | 517-676-1070
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MEAGHAN RINALDI
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Credential |
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Telephone | 517-676-1070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253J00000X
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Taxonomy Name | Foster Care Agency
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License Number |
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License Number State |
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