Provider Demographics
NPI:1275072654
Name:GRAGEVI AFC HOME
Entity Type:Organization
Organization Name:GRAGEVI AFC HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADULT FOSTER CARE PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAGEVI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-257-6956
Mailing Address - Street 1:5408 MILLS RIDGE DR SW
Mailing Address - Street 2:
Mailing Address - City:GRANDVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49418-8390
Mailing Address - Country:US
Mailing Address - Phone:616-257-6956
Mailing Address - Fax:
Practice Address - Street 1:5408 MILLS RIDGE DR SW
Practice Address - Street 2:
Practice Address - City:GRANDVILLE
Practice Address - State:MI
Practice Address - Zip Code:49418-8390
Practice Address - Country:US
Practice Address - Phone:616-257-6956
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-17
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency