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General NPI Number Information
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NPI Number | 1780112383
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Entity Type | Individual
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Provider Name | COLENE A. SNOWDEN AFC PROVIDER
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Gender | Female
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Dates
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Enumeration Date | 05/25/2017
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Last Update Date | 05/25/2017
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Provider Practice Location Address
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Address Line | 18331 TIPSICO LAKE RD
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City | FENTON
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State | MI
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Zip | 48430-8554
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Country | US
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Telephone | 810-629-0251
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Fax | 810-629-0251
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Provider Business Mailing Address
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Address Line | 18331 TIPSICO LAKE RD
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City | FENTON
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State | MI
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Zip | 48430-8554
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Country | US
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Telephone | 810-629-0251
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Fax | 810-629-0251
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number | AF630004934
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License Number State | MI
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