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General NPI Number Information
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NPI Number | 1609737113
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Entity Type | Organization
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Legal Business Name | FORTY MILE FAMILY FARMS LLC
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Dates
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Enumeration Date | 11/24/2025
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Last Update Date | 11/24/2025
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Provider Practice Location Address
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Address Line | 6491 HIVON RD
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City | CARLETON
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State | MI
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Zip | 48117-9547
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Country | US
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Telephone | 567-343-3238
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Fax |
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Provider Business Mailing Address
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Address Line | 1921 KNOLLWOOD BND
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City | YPSILANTI
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State | MI
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Zip | 48198-9551
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Country | US
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Telephone | 567-343-3238
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Fax |
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Authorized Official
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Title or Position | BARN MANAGER
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Name | MR. MAJE-LLOYD HOGAN
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Credential |
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Telephone | 567-343-3238
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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