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General NPI Number Information
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NPI Number | 1619404308
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Entity Type | Organization
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Legal Business Name | SHEDRICE'S AFC
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Dates
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Enumeration Date | 05/12/2017
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Last Update Date | 05/12/2017
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Provider Practice Location Address
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Address Line | 246 POWELL SE AVE
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City | GRAND RAPIDS
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State | MI
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Zip | 49507
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Country | US
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Telephone | 616-248-1720
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Fax | 616-248-1720
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Provider Business Mailing Address
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Address Line | 246 POWELL ST SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49507-1176
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Country | US
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Telephone | 616-248-1720
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Fax | 616-248-1720
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Authorized Official
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Title or Position | OWENER
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Name | SHELIA LYNN BURRELL
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Credential |
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Telephone | 616-248-1720
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385HR2060X
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Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
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License Number | AS410385361
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License Number State | MI
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