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General NPI Number Information
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NPI Number | 1689002248
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Entity Type | Organization
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Legal Business Name | LONG ACRES AFC
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Dates
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Enumeration Date | 10/17/2013
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Last Update Date | 10/17/2013
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Provider Practice Location Address
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Address Line | 11793 N RED BUD TRL
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City | BUCHANAN
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State | MI
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Zip | 49107-9161
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Country | US
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Telephone | 269-473-2156
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Fax |
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Provider Business Mailing Address
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Address Line | 3955 ROSE DR
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City | BERRIEN SPRINGS
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State | MI
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Zip | 49103-9510
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Country | US
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Telephone | 269-408-8547
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Fax | 269-471-5501
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Authorized Official
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Title or Position | OWNER
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Name | STAN SAVERUS
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Credential |
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Telephone | 269-408-8547
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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 | AM110083631
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License Number State | MI
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