MEDICARE: EVA'S AFC HOME, LLC

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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1902440068
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVA'S AFC HOME, LLC

Provider Business Mailing Address
First Line	:	3151 136TH AVE
Second Line	:
City	:	HAMILTON
State	:	MI
Zip	:	49419-9548
Country	:	US
Telephone Number	:	731-792-5112
Fax Number	:

Provider Business Practice Location Address
First Line	:	3151 136TH AVE
Second Line	:
City	:	HAMILTON
State	:	MI
Zip	:	49419-9548
Country	:	US
Telephone Number	:	731-792-5112
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	K'LEE ANN FELTY
Credential	:
Telephone Number	:	731-792-5112

Provider Enumeration Date	:	11/01/2019
Last Update Date	:	11/01/2019

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