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General NPI Number Information
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NPI Number | 1760922637
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Entity Type | Organization
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Legal Business Name | BRENDAS LITTLE ACRES LLC
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Dates
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Enumeration Date | 02/27/2017
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Last Update Date | 02/27/2017
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Provider Practice Location Address
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Address Line | 12068 36TH ST SE
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City | LOWELL
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State | MI
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Zip | 49331-9509
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Country | US
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Telephone | 616-897-8340
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Fax | 616-897-8343
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Provider Business Mailing Address
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Address Line | 12068 36TH ST SE
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City | LOWELL
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State | MI
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Zip | 49331-9509
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Country | US
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Telephone | 616-897-8340
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Fax | 616-897-8343
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Authorized Official
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Title or Position | LICENSEE/ADMINISTATOR
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Name | MRS. BRENDA LEE CANTER
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Credential |
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Telephone | 616-897-8340
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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 | AM410293632
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License Number State | MI
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