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General NPI Number Information
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NPI Number | 1871032417
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Entity Type | Organization
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Legal Business Name | BLUEBIRD AFC MANOR
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Dates
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Enumeration Date | 02/15/2017
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Last Update Date | 02/15/2017
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Provider Practice Location Address
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Address Line | 3571 BLUEBIRD AVE SW
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City | WYOMING
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State | MI
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Zip | 49519-3103
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Country | US
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Telephone | 616-261-0994
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Fax | 616-259-7892
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Provider Business Mailing Address
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Address Line | 3571 BLUEBIRD AVE SW
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City | WYOMING
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State | MI
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Zip | 49519-3103
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Country | US
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Telephone | 616-261-0994
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Fax | 616-259-7892
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Authorized Official
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Title or Position | LICENSEE/OWNER
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Name | BETH ANN SKAZINSKI
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Credential |
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Telephone | 616-261-0994
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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 | AF410075156
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License Number State | MI
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