=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801055371
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BEEMER AFC HOMES CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/09/2008
-----------------------------------------------------
Last Update Date | 06/09/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 406 W 5TH ST
-----------------------------------------------------
City | EVART
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49631-9302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 231-734-3810
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 406 W 5TH ST
-----------------------------------------------------
City | EVART
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49631-9302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 231-734-3810
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | HOME OWNER
-----------------------------------------------------
Name | DENNIS L BEEMER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 231-734-3810
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253J00000X
-----------------------------------------------------
Taxonomy Name | Foster Care Agency
-----------------------------------------------------
License Number | AM670009368
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------