MEDICARE: THREN AFC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253J00000X	Foster Care Agency	AF370237382	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	892786017	OTHER	MI	BLUE CROSS/BLUE SHIELD

General Provider Information

NPI Number	:	1669743225
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THREN AFC

Provider Business Mailing Address
First Line	:	5806 W WEIDMAN RD
Second Line	:
City	:	WEIDMAN
State	:	MI
Zip	:	48893
Country	:	US
Telephone Number	:	989-644-8701
Fax Number	:

Provider Business Practice Location Address
First Line	:	5806 W WEIDMAN RD
Second Line	:
City	:	WEIDMAN
State	:	MI
Zip	:	48893
Country	:	US
Telephone Number	:	989-644-8701
Fax Number	:

Authorized Official
Title or Position	:	FOSTER CARE PROVIDER
Name	:	MS. KAY LYNN THREN
Credential	:
Telephone Number	:	989-644-8701

Provider Enumeration Date	:	01/13/2012
Last Update Date	:	01/13/2012

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Directions to “THREN AFC ” Practice Location

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