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General NPI Number Information
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NPI Number | 1558178590
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Entity Type | Organization
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Legal Business Name | OBEDI FAMILY AFC LLC
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Dates
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Enumeration Date | 12/13/2024
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Last Update Date | 12/13/2024
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Provider Practice Location Address
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Address Line | 3036 PERRY AVE SW
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City | WYOMING
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State | MI
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Zip | 49519-2531
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Country | US
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Telephone | 616-540-3193
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Fax |
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Provider Business Mailing Address
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Address Line | 3036 PERRY AVE SW
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City | WYOMING
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State | MI
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Zip | 49519-2531
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Country | US
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Telephone | 616-540-3193
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CLAUDE NDAHIRIWE RUVUGWA
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Credential | DIPLOMA
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Telephone | 616-540-3193
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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 |
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License Number State |
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