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General NPI Number Information
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NPI Number | 1962839936
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Entity Type | Organization
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Legal Business Name | COZY HILL A.F.C. L.L.C.
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Dates
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Enumeration Date | 10/04/2013
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Last Update Date | 10/04/2013
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Provider Practice Location Address
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Address Line | 09441 44TH STREET
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City | BLOOMINGDALE
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State | MI
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Zip | 49026
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Country | US
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Telephone | 269-521-7667
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Fax | 269-521-7667
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Provider Business Mailing Address
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Address Line | 09441 44TH STREET
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City | BLOOMINGDALE
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State | MI
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Zip | 49026
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Country | US
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Telephone | 269-521-7667
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Fax | 269-521-7667
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Authorized Official
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Title or Position | OWNER
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Name | MR. STEVE H STASSEK
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Credential |
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Telephone | 269-521-7667
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AF800274033
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License Number State | MI
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