Lake Shore Afc, LLC
Assisted Living Facility, Assisted Living, Behavioral Disturbances in Grawn, MI. Organization (NPI-2).
NPI number1669968129
StatusActive
Last updated in NPPESJul 9, 2018
Details
- NPI
- 1669968129
- Entity type
- Organization (NPI-2)
- Legal business name
- Lake Shore Afc, LLC
- Organization subpart
- No
- Enumeration date
- Jul 9, 2018
- Last updated
- Jul 9, 2018
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 3104A0630X | Assisted Living Facility, Assisted Living, Behavioral Disturbances | AM280289926 | MI | Yes |
Other names
- Lake Shore Afc, LLC (Doing Business As)
Practice location
2480 Tonawanda Lake RdGrawn, MI 49637-9615
Phone 231-276-9260 · Fax 231-276-9380
Mailing address
Po Box 119Grawn, MI 49637-0119
Phone 231-276-9260 · Fax 231-276-9380
Authorized official
Randy John Scholtus
Administrator
2312769260
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